Job Description:
• Plan and perform medical record audits to determine coding accuracy and compliant claims submission
• Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance
• Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines
• Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement
• Serve as a subject matter expert on interpretation and application of coding and documentation guidelines
• Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas
• Stay current on coding guidelines
• Develop analyses using transactional data and/or financial data
• Generate client deliverables and make valuable contributions to expert reports
• Manage client relationships and communicate results and work product as appropriate
• Manage junior staff and delegate assignments as directed by more senior managers
• Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions
• Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting
• Prioritize assignments and responsibilities to meet goals and deadlines
Requirements:
• An undergraduate degree (e.g., BS, BA)
• Active coding certification from either AAPC or AHIMA is required
• Preference will be given to candidates that are certified in medical auditing
• 2+ years of work experience with a focus on healthcare provider billing and coding
• 5-7 years of experience is required for the Managing Consultant level position
• Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs)
• Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation
• Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements.
• Required skills include: Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results.
• Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word.
• A desire to expand those capabilities is required, as is the ability to train others to use such tools.
• Commitment to producing high quality analysis and attention to detail.
• Excellent time management, organizational skills, and ability to prioritize work and meet deadlines.
• Keen interest in healthcare compliance and healthcare policy.
• Exceptional verbal and written communication skills.
• Desire to work within a team environment.
• Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship.
Benefits:
• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development opportunities
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