Pro Fee Auditor / Educator
Presbyterian Healthcare Services
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteSalary
💰 $26 - $40 per hour
Job Level
Mid-LevelSenior
Tech Stack
PHP
About the role
- Support Coding and Documentation Quality Assurance (CDQA) team with implementation and compliance to enterprise and department coding policies and procedures
- Perform and/or manage on-site internal audits or reviews to assess compliance/quality monitoring
- Serve as a resource on documentation, coding, billing, and coding compliance questions
- Work on special coding compliance projects, develop and present educational programs, and develop educational tools
- Audit and train on enterprise-wide corrective action plans for coding and low-performing physician and clinician personnel
- Perform medical record and billing reviews of denied and appealed claims; coordinate review and tracking of appealed claims and communicate with payers
- Research and interpret regulatory agency regulations and maintain up-to-date technical knowledge (ICD-9, ICD-10, CPT-4, HCPCS, APC)
- Research coding, billing and charging compliance issues, recommend and implement corrective action plans
- Identify risks, develop action plans, identify lost revenue opportunities and overpayments, and provide compliance education
- Assist in creation of CDQA Annual Audit Work-plan using OIG work plan, Medicare/Medicaid regulations, RAC and other audit focuses
- Respond to inquiries and requests regarding coding and auditing issues and perform ad-hoc analyses for PHS management
- Conduct training classes in coding, documentation and compliance, including ICD-10 and EPIC EMR documentation education for providers and clinical staff
- Conduct systematic focused internal audits via medical record and charge ticket review as part of CDQA audit team
- Analyze and summarize audit data and communicate results to management
- Develop new methods and processes to improve coding efficiency and effectiveness
- Ensure coding functions meet established quality and performance standards by monitoring reports and quality audits
Requirements
- High school diploma/GED required
- Must have any one of the following coding certifications at time of hire: CCS, CCS-P, CPC-H, or RHIT/RHIA; if not, achievement of one of the coding credentials above within one year of hire
- Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS
- Minimum of three (3) years experience in coding and/or auditing required (Three to five years experience as a coder required)
- Audit experience preferred
- Excellent written and verbal communication skills
- Detail and results oriented
- Ability to work independently and make independent decisions
- Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required
- Proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for assigned service lines
- Excellent organizational and planning skills, ability to prioritize multiple tasks and perform them accurately and simultaneously
- Computer skills, especially Microsoft Word, PowerPoint, and Excel
- Ability to use the internet and other resource applications for research and documentation
- Must possess strong written and verbal communication skills to communicate complex regulatory information in layman’s terms
- Must possess personal presence characterized by honesty, integrity, and ability to inspire and motivate others
- Must be able to travel to all of the PHS/PMG sites (including overnight)