ENTERPRISE WIDE CODING AUDITOR-ABQ PAC Full-Time Job Listing at Presbyterian Health Services in Albuquerque, NM

Hospital / Healthcare, Health Products & Services

ENTERPRISE WIDE CODING AUDITOR-ABQ PAC Full-Time
Requisition Number: 42100
Location: NM-Albuquerque
Type of Opportunity: Regular Full-Time
FLSA Classification: EXEMPT
Minimum Experience: 3 years
Minimum Education:
Shift: Days

Minimum Skills/Requirements

High school diploma/GED required. Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS and a minimum of three (3) years experience in coding and/or auditing 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.

Must have a proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for service lines(s) assigned.

Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously.

Must possess 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 in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in layman’s terms.

Must possess a personal presence of a highly qualified professional that is characterized by a sense of honesty, integrity, and the ability to inspire and motivate others.

Primary Job Functions

• Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management.

• Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form.

• Must be able to adapt to frequently changing work priorities and schedules. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes.

• Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Identifies risks, develops and follows up on action plans, identifies lost revenue opportunities and any overpayments due to errors in coding and/or documentation, and provides compliance education.

• Uses an integrated approach to perform audits by investigating, documenting, linking, reporting, and following-up on the status of significant matters, findings, and/or potential issues originating from or impacting areas beyond the obvious scope of each individual provider and/or facility audits (e.g. EMR/system issues).

• Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments.

• Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. Keeps actively informed on the business climate of the healthcare industry.

• Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.

• Maintains up-to-date working knowledge of all PHS coding and auditing IT applications.

• Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group.

• Conducts training and education classes in areas of coding, documentation and compliance for PHS/PMG personnel. This includes preparation of training materials, educational audits and answering specific situational questions, ICD-10 education and EPIC EMR documentation education to providers and clinical staff.

• Conducts systematic focused internal audits via medical record and charge ticket review to insure correct coding, billing and charging as a member of CDQA audit team.

• Analyzes and summarizes data from medical record and account audits and communicates results and findings to management and compliance.

• Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care.

• Ensures that coding functions are performed in accordance with established quality and performance standards by monitoring system generated reports and quality audits.

• Working hours may vary based on projects assigned.

• Must be able to travel to all of the PHS/PMG sites (including overnight). Travel varies at certain times based on assignments.

• Performs other functions as required.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.