The Revenue Cycle Management Auditor audits medical record documentation to identify under coded and up coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues. Interacts with providers and management to review and/or implement codes and to update charge documents. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.

Location: Remote

Schedule: 40hrs

Target Pay: $32.00-$37.00 per hour - Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.

RESPONSIBILITIES:

• Responsible for examining medical records, clinical documentation and claims to verify the accuracy and completeness of assigned codes.
• Responsible for identifying discrepancies, errors and inconsistencies in coding and billing practice. Including the potential of fraud, waste, and abuse (FWA).
• Ensures all federal and state regulations, Medicare and Medicaid rules and other payer guidelines are being followed
• Creates reports on identified errors and trends and recommends process improvements to management
• Collaborates with compliance, billing, clinical and clinical leadership to resolve any coding discrepancies.
• Responsible for maintaining a tracking system for all audits/requests activity throughout all levels of appeals.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
• Reviewing Chart Records to confirm accurate documentation to decrease audit concerns and documenting findings.
• Assisting our Compliance Officer with coding training documentation to better equip our providers
• Establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility's interactions with third party auditors
• Pre and post payment Medicare, Medicaid and commercial insurance reviews to ensure timely completion or review/audit documentation requests.
• Regular and predictable attendance is required.

• All other duties as assigned.

COMPETENCIES:

Demonstrates Self Awareness

• Reflects on activities and impact on others.
• Proactively seeks feedback without being defensive.
• Is open to criticism and talking about shortcomings.
• Admits mistakes and gains insight from experiences.
• Knows strengths, weaknesses, opportunities, and limits.

Action Oriented

• Readily takes action on challenges, without unnecessary planning.
• Identifies and seizes new opportunities.
• Displays a can-do-attitude in good and bad times.
• Steps up to handle tough issues.

Takes Ownership/Ensures Accountability

• Follows through on commitments and makes sure others do the same.
• Acts with a clear sense of ownership.
• Takes personal responsibility for decisions, actions, and failures.
• Establishes clear responsibilities and processes for monitoring work and measuring results.
• Designs feedback loops into work.

Communicates Effectively

• Is effective in a variety of communication settings: one-on-one, small and large groups, or among diverse styles and position levels.
• Attentively listens to others.
• Adjusts to fit the audience and the message.
• Provides timely and helpful information to others across the organization.
• Encourages the open expression of diverse ideas and opinions.

Nimble Learning

• Learns quickly when facing new situations.
• Experiments to find new solutions.
• Takes on the challenge of unfamiliar tasks.
• Extracts lessons learned from failures and mistakes.

QUALIFICATIONS:

• Requires a AA/AS and minimum of 4 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.
• 3 years of provider chart auditing experience
• Extensive ICD-10 and CPT coding experience
• Requires coding certification -CPC, CCS, CPMA, COC OR RHIT certification.
• Ability to read and understand oral and written instructions and follow written protocols.
• Ability to examine documents for accuracy and completeness.
• Ability to provide excellent customer service.
• Skill in presenting information in an organized manner.
• Skill in verbal and written communication.

• Consistent access to a private work environment with high speed internet and professionally appropriate surroundings for frequent video conferencing and a workstation setup conducive to remote work needs.

PHYSICAL REQUIREMENTS:

• Constantly operate a computer and other related peripherals such as a keyboard, mouse, headset etc.
• Must be able to remain in a stationary position a majority of the time working.
• Frequent communication via remote meeting software; softphones or cell phones.
• Predominantly working in the employees home, indoor, office setup.

#LIRemote #zr