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Coding Compliance Auditor - Remote

Job ID: 2005042107 Date posted: 12/06/2020 Facility: Conifer Health Solutions
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Job Details

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
JOB SUMMARY
Conducts routine and risk-based coding compliance audits, random quality compliance audits, and semi-annual quality compliance audits of professional fee encounters to validate code assignments are in compliance with official coding guidelines as supported by clinical documentation in the health record. Validates abstracted data elements that are integral to appropriate payment methodology.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
  • 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.


Qualifications:

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

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • 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

Include minimum education, technical training, and/or experience preferred to perform the job.
  • 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
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
  • AHIMA and/or AAPC Coding Credential, CCS-P preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • 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
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Remote – Telecommuting
TRAVEL
  • Approximately 15% travel may be required
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days

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.

E-Verify: http://www.uscis.gov/e-verify

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