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Coding Compliance Auditor - Remote
- Understands, interprets and applies coding guidelines for coding audits ofmulti-specialty professional encounters. Performs medical record reviews to determine coding accuracy of evaluation and management services, surgical and office-based procedures, and diagnosis codes. Validates compliance with non-physician practitioner billing, teaching physician and scribe services, as applicable. Conducts overall claims review to validate reporting accuracy of codes impacting professional reimbursement including, but not limited to, CPT, ICD-10-CM, HCPCS, Modifier and POS.
- Creates clear, concise and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Healthcare Providers, Coders, Auditors, Managers, and Directors throughout the organization.
- Identifies documentation issues (lacking documentation, split/shared visit services, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
- Stays current with CMS, AHA, AMA/CPT and ICD-10-CM Official Coding and Reporting Guidelines, and other agency directives for professional fee coding. Completes online education courses and attends mandatory coding workshops and/or seminars (MPFS, IPPS, and OPPS, ICD-10-CM and CPT updates) for all coding types.. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):
- Provides input regarding departmental budget specific to area of responsibility.
Conifer requires its candidates and contractors, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES
- Ability to consistently and accurately audit coding of professional fee encounters
- Ability to create clear and concise audit reports
- Maintain productivity standards
- Must successfully pass pre-hire professional fee coding assessment
- Knowledge of CMS, ICD-10-CM, CPT-4 and HCPCS coding regulations, guidelines and methodologies
- Knowledge of medical terminology, anatomy, disease pathophysiology and drug utilization
- Knowledge of billing guidelines related to correct claim submission including POS and billing provider
- Knowledge of NCCI classification and reimbursement structures
- Must be detail oriented and have the ability to work independently
- Computer knowledge of MS Office
- Must display excellent interpersonal skills
- Ability to demonstrate initiative and discipline in time management and assignment completion
- Ability to work in a virtual setting under minimal supervision
EDUCATION / EXPERIENCE
- Associates degree in relevant field preferred or combination of equivalent of education and experience
- Three (3) years coding experience with a focus on professional fee coding
- One (1) year of experience in coding audit or quality review work of professional fee services in multiple specialties
- AHIMA and/or AAPC Coding Credential, CCS-P preferred
- Must be able to work in sitting position for extended periods
- Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone
- Ability to travel
- Duties may require driving an automobile to off- site locations.
- Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
- Remote – Telecommuting
- Approximately 15% travel may be required
Employment practices will not be influenced or affected by an applicant’s or
employee’s race, color, religion, sex (including pregnancy), national origin,
age, disability, genetic information, sexual orientation, gender identity or
expression, veteran status or any other legally protected status. Tenet will
make reasonable accommodations for qualified individuals with disabilities
unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
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