Advantia Health

Auditor

• Responsible for auditing the providers' coding and documentation to effectively provide feedback and education.
• Provide training tools and tips to new and existing providers, as well as ongoing group training opportunities.
• Build relationships with our external physicians while conducting medical record reviews, monitoring, analyzing coding patterns, and providing virtual education.
• Provide coding expertise as well as administrative oversight to improve the overall quality of the documentation; ensuring that it is to the highest level of specificity in accordance with the CMS guidelines.
• Comfortable and confident to communicate coding requirements to physicians/providers so that physicians understand what/how to document for the services they are performing.
• Audits and educates providers and coders on a quarterly schedule.
• Creates coding education curriculum to train providers how to document and understand how documentation relates to codes.
• Conducts virtual meetings with providers to provide one on one or group training and education.
• Creates an auditing system to effectively audit findings and deliver outcomes.
• Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
• Develops education materials to assist physicians in accurately assessing patients’ overall health status.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Advantia Health provider network.
• Identifies issues, and reports results timely to ensure that physicians remain in compliance.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff in Coding and Documentation including CMS Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggest customizations of coding and documentation for various audiences; Support Staff, Providers, Specialists, and Employees.
• Stays current on industry coding, compliance and HCC issues.

RCM CPC Auditor, Educator