Outpatient Coding Consultant
Datavant
Pro Fee Auditor/Educator
Presbyterian Healthcare Services
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $26 - $40 per hour
Job Level
Mid-LevelSenior
Tech Stack
PHP
About the role
- With minimal supervision supports Coding and documentation quality assurance (CDQA) team responsibilities
- Implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS
- Ensure compliance to all external regulatory agency coding rules and regulations
- 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 related projects, develop and present educational programs, and disseminate information to PHS/PMG departments
- Provide support via auditing and training enterprise-wide corrective action plans for coding, audit, physician and clinician personnel
- Perform medical record and billing reviews of denied and appealed claims and coordinate review and tracking of appealed claims including communication with affected payers
- Research and interpret regulatory agency regulations
- Liaison to Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and ancillary departments
- Maintain accurate, complete and timely documentation in electronic or hard copy form
- Adapt to frequently changing work priorities and schedules
- Maintain and disseminate up-to-date technical knowledge of legal and regulatory information including ICD-9, ICD-10, CPT-4, HCPCS and APC updates
- Research coding, billing and charging compliance issues, recommend and implement corrective action plans
- Identify risks, develop and follow up on action plans, identify lost revenue opportunities and any overpayments due to errors
- Assist in creation of the CDQA Annual Audit Work-plan using OIG work plan, Medicare and Medicaid regulations, RAC and other audit focuses
- Exercise independent judgment in determining reliability of data and recommend changes in practices
- Respond to inquiries and requests daily regarding coding and auditing issues and ad-hoc analysis for PHS management
- Maintain up-to-date working knowledge of all PHS coding and auditing IT applications
- Gather and analyze information and provide recommendations to resolve business issues
- Conduct training classes in coding, documentation and compliance, including ICD-10 education and EPIC EMR documentation education
- Conduct systematic focused internal audits via medical record and charge ticket review
- Analyze and summarize data from audits and communicate results and findings to management and compliance
- Develop new methods and processes to improve coding efficiency and effectiveness
- Research and investigate external and internal customer concerns regarding patient care and/or billing
- Ensure coding functions are performed in accordance with established quality and performance standards
- Travel to all PHS/PMG sites as required; travel may include overnight stays
Requirements
- Must have any one of the following coding certifications at time of hire: CCS, CCS-P, CPC-H, or RHIT/RHIA (or achieve one within one year of hire)
- Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS
- Three to five years experience as a coder required
- Minimum of three (3) years experience in coding and/or auditing required
- Audit experience preferred
- High school diploma/GED required
- 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 service lines(s) assigned
- Excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously
- Computer skills, especially with Microsoft Word, PowerPoint, and Excel applications
- Must be able to use the internet and other resource applications for research purposes and to provide documentation that supports regulations quoted in audits
- Must possess strong written and verbal communication skills to communicate with management at all levels
- Must possess a personal presence characterized by honesty, integrity, and the ability to inspire and motivate others
- Must be able to travel to all of the PHS/PMG sites (including overnight)
