CODING AND QA AUDITOR
Requisition ID 2020-17699 Category Coding/Abstracting Default: Area: City Albuquerque Area: Name 9521 San Mateo NE Albuquerque, NM 87113-2237 Default: Area: State/Province (Full Name) New Mexico
Introduction
Job Description
Type of Opportunity: Full-time
FTE: 1.000000
Exempt: Yes
Work Set Up: Days
Summary:
With minimal guidance directly supports the following responsibilities of the Coding and paperwork quality assurance (CDQA) group: implementation of and compliance to enterprise-wide and department coding policies and treatments for PHS; compliance to all external regulative company coding rules and regulations; Demonstrates high-level of efficiency in performing and/or managing on-site internal audits or reviews to evaluate compliance/quality tracking performed by PHS/PMG departments while serving as a resource on paperwork, coding, billing, and coding compliance concerns. Functions on unique coding compliance associated projects, establishes and presents curricula, shares details to PHS/PMG departments and develops instructional tools utilized to preserve compliance with guidelines. Offers support by means of auditing and training the enterprise-wide restorative action plans for coding, audit, physician and clinician personnel identified as low entertainers; perform medical record and billing evaluations of rejected and appealed claims and takes proper action to make sure precise payment of claims; coordinate review and tracking of appealed claims including the interaction procedure with affected payers; research study and analyze all regulative firm regulations
Obligations
Responsibilities:
Liaison to the Supervisor, Details Solutions, Finance/Patient Financial Providers, all medical facilities, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in attending to functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management.esponsible for keeping accurate, complete and timely documents in either electronic or hard copy kind
Should be able to adapt to regularly altering work concerns and schedules. Maintains and disseminates current technical knowledge of legal and regulative details from all proper jurisdictions worrying the given service location. This consists of however is not restricted to all ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes
Researches coding, billing and charging compliance concerns, advises and carries out restorative action plans that assure compliance with regulatory companies where appropriate. Determines threats, develops and follows up on action strategies, determines lost revenue opportunities and any overpayments due to mistakes in coding and/or paperwork, and provides compliance education
Assists in the creation of the CDQA Annual Audit Work-plan by making use of the OIG work plan, Medicare and Medicaid guidelines, RAC and other audit agency focuses, as well as internal and external risk evaluations
Routinely works out independent judgment in identifying the reliability of data reviewed; recommends changes in existing practices to get or keep compliant behavior. Keeps actively notified on the business environment of the health care market
Reacts to inquiries and requests daily relating to coding and auditing issues and problems and ad-hoc analysis for all PHS management
Preserves updated working knowledge of all PHS coding and auditing IT applications
Gathers and evaluates information and offers recommendations to attend to and deal with company issues for a specific service group
Conducts training classes in locations of coding, documents and compliance for PHS/PMG workers. This includes preparation of training materials, instructional audits and answering specific situational questions, ICD-10 education and LEGENDARY EMR documentation education to providers and scientific staff
Performs methodical focused internal audits by means of medical record and charge ticket evaluation to insure appropriate coding, billing and charging as member of CDQA audit team
Analyzes and summarizes data from medical record and account audits and communicate outcomes and findings to management and complianceDevelops new approaches and processes to enhance coding efficiency and efficiency
Researches and investigates external and internal consumer issues relating to client care and/or billing of client care. Makes sure that coding functions are performed in accordance with recognized quality and efficiency requirements by keeping track of system produced reports and quality audits
Working hours may differ based upon jobs designated
Must have the ability to travel to all of the PHS/PMG websites (consisting of over night). Travel varies at particular times based on projects
B
Certifications
High school diploma/GED needed. Must have a minimum of 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. Outstanding composed and spoken communication skills. Excellent written and spoken communication skills. Information and results oriented. Capability to work individually and make independent decisions. Medical terminology, ICD-9, CPT-4 and HCPCS understanding needed.
Should have a skilled understanding of Medicare, Medicaid, and other 3rd party payer documents, coding, and billing policies for service lines( s) appointed.
Must possess outstanding organizational and preparation skills, including the capability to focus on multiple jobs and perform them both precisely and at the same time.
Needs to have computer skills, especially with Microsoft Word, PowerPoint, and Excel applications. Need to be able to use the internet and other resource applications for research functions and to provide documents that supports policies quoted in audits.
Should possess strong composed and spoken interaction abilities in order to interact in clear, succinct terms to management at all levels, including the capability to articulate complicated regulatory info in laymans terms.
Should possess a personal presence of an extremely qualified professional that is characterized by a sense of honesty, integrity, and the ability to inspire and motivate others.
Education:
Necessary:
- High School Diploma or GED
Credentials:
Necessary:
- Qualified Professional Coder
Benefits
Advantages work day-one (for.45 FTE and above) and consist of:
- Competitive salaries
- Complete medical, oral and vision insurance
- Versatile spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and profession development chances
- Life insurance and short/long term special needs programs
About United States
Presbyterian Health Care Providers is a locally owned, not-for-profit healthcare system of 9 medical facilities, a statewide health plan and a growing multi-specialty medical group. Established in New Mexico in 1908, it is the state’s biggest private company with approximately 11,000 staff members.
Presbyterian’s story is really the story of the remarkable people who have actually picked to work here. Beginning with Reverend Cooper who began our journey in 1908, the effort of thousands of doctors, staff members, board members, and other volunteers brought Presbyterian from a small tuberculosis sanatorium to a statewide health care system, serving more than 700,000 New Mexicans.
We are part of New Mexico’s history – and dedicated to its future. That is why we will continue to work just as difficult and care just as deeply to serve New Mexico for several years to come.
About New Mexico
New Mexico’s special blend of Spanish, Mexican and Native American impacts contribute to a culturally abundant lifestyle. Include Albuquerque’s International Balloon Fiesta, Los Alamos’ nuclear scientists, Roswell’s visitors from deep space, and Santa Fe’s artists, and you get a diverse mix of people, locations and experiences that make this state excellent.
Cities in New Mexico are continually ranked amongst the nation’s finest places to work and live by Forbes publication, Kiplinger’s Personal Financing, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers limitless recreational opportunities to check out, and delight in an active way of life. Endeavor off the beaten path, challenge your body in the components, or open yourself as much as the extensive sky. From treking, playing golf and cycling to snowboarding, snowboarding and boating, it’s all available among our gorgeous wonders of the west.
AA/EOE/VET/ DISABLED. PHS is a drug-free and tobacco-free company with smoke totally free schools.
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Presbyterian Health Solutions.
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