RCM CPC Auditor, Educator
Advantia Health
full-time
Posted on:
Location Type: Office
Location: Arlington • Virginia • United States
Visit company websiteExplore more
About the role
- 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.
Requirements
- Proven experience as a CPC
- Familiarity with all CMS guidelines
- Working knowledge of MS Office and databases
- Excellent communication and interpersonal skills
- Ability to handle sensitive, confidential information
- Self-starter, with the ability to work independently and resourcefully.
- 2+ years of Athena experience and or super user
- Certified Professional Coder and Registered Health Information Technician (RHIT)
- At least 10 years in profee coding/auditing/education experience for OBGYN specialties: maternal fetal medicine, complex OB, Mammography.
- Needs strong surgical experience and E&M Leveling
- 5-7 years' experience within Revenue Cycle
- Effective Communication, presentation and project management
- Excellent problem solving, written and verbal communication skills, with the ability to clearly explain technical reasoning.
- Proficient experience in computer technology, including Microsoft word, PowerPoint and Excel.
- Strong Training and evaluative skills
Benefits
- Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
CPCCMS guidelinesprofee codingauditingeducationsurgical codingE&M LevelingRisk Adjustment Data Validationcoding expertisedocumentation specificity
Soft Skills
communication skillsinterpersonal skillsproblem solvingpresentation skillsproject managementself-starterability to handle confidential informationtraining skillsevaluative skillsresourcefulness
Certifications
Certified Professional CoderRegistered Health Information Technician (RHIT)