Auditor

• Support Coding and Documentation Quality Assurance (CDQA) team: implement and ensure compliance with enterprise-wide and department coding policies and procedures
• Perform/manage on-site internal audits or reviews to assess compliance and 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 tools
• Audit and train enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers
• Perform medical record and billing reviews of denied and appealed claims; take appropriate action to ensure accurate payment and coordinate review and tracking of appealed claims with payers
• Research and interpret regulatory agency regulations
• Liaison to Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and ancillary departments
• Maintain accurate documentation and up-to-date technical knowledge of legal and regulatory information (ICD-9, ICD-10, CPT-4, HCPCS, APC updates)
• Research compliance issues, recommend and implement corrective action plans, identify lost revenue and overpayments
• Assist in creation of the CDQA Annual Audit Work-plan using OIG work plan, Medicare/Medicaid regulations, RAC, and risk assessments
• Conduct training classes and prepare training materials, including ICD-10 education and EPIC EMR documentation education for providers and clinical staff
• Conduct systematic focused internal audits via medical record and charge ticket review and analyze/summarize audit data for management
• Develop new methods and processes to improve coding efficiency and effectiveness
• Investigate customer concerns regarding patient care and billing and ensure coding functions meet quality and performance standards
• Maintain working knowledge of PHS coding and auditing IT applications
• Travel to all PHS/PMG sites as required; working hours may vary based on projects

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