Physicians/Pro Fee Auditor

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Norwood Staffing

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Coding Quality Specialist I


Must live in TX, LA, Arkansas, GA, NM, Oklahoma, Nevada.

Salary range for HIRE – 65,000-70,000

Monday-Friday 8 hour days

Job Description/Additional Details:

Selected by client's Health Coding Leadership to focus coding skills and expertise on internal departmental audits in support of the client's Physician Billing Coding Department. Coding Quality Specialist will complete internal coding audits and report in a format that provides ongoing departmental quality control services and feedback to coding staff. Coding Quality Specialist will demonstrate high-quality knowledge and understanding of CPT, HCPCS, ICD-10-CM, and coding guidelines and practices for physician-based professional services in both acute care and ambulatory settings. The Quality Specialist will have a strong working knowledge of client's Health applications, in addition to other applicable software that may be required for auditing. Coding Quality Specialist will maintain a regular schedule of audit assignments, to ensure every coder within the department is audited and has received the necessary feedback, education, and/or remediation, based on the frequency schedule outlined by Quality Program. Coding Quality Specialist will audit for quality in regards to procedural coding, Evaluation & Management (E/M coding, principal and secondary diagnosis code assignment, modifier usage, and medical policy (LCD/NCD) accuracy. The Quality Specialist will create and maintain regular reporting of audit results, to track and trend audit scores, and to identify both the strengths and weaknesses within the department. Coding Quality Specialist will assist with the development of corrective action plans, provide new hire training, and serve as an overall mentor to the coding team. Coding Quality Specialist will also assist in other areas of the Coding Department, as requested by leadership. Coding Audit Specialist will report directly to the Coding Director, with additional leadership from the Director of Revenue Cycle Audit. • Facilitate and complete physician-based inpatient and outpatient coding audits. • Communicates audit results both verbally and in writing in an approved, appropriate format • Assist with development and coordination of audit plans, feedback to coding staff and management to include accurate code assignment (CPT, ICD-10-CM, HCPCS), documentation opportunities, accurate modifier assignment, query opportunities, compliance and data management. • Assist with chart sample selection for audit and coordinates with Coding Supervisors/Managers. • Reviews audit results and performs trend analyses to identify accuracy patterns, and variations in coding practices which require education. • Meets or exceeds an audit accuracy rate of 95%. • Ensure coding audits are appropriate and effective. Assesses effectiveness through associate evaluations. • Performs education sessions for coders as necessary. • Provides support to coding team for coding questions. • All other work duties as assigned by Director. POSITION QUALIFICATIONS A. Education/Skills • High school diploma or GED. • Completion of accredited AAPC or AHIMA approved Coding Certificate Program. • Strong written and verbal communication skills. • Able to work independently in a remote setting, with little supervision. B. Experience • Five (5) or more years of audit experience in a physician-based practice setting, for inpatient acute care and outpatient/ambulatory services. Audit experience should include both Evaluation & Management (E/M), inpatient and outpatient procedures. • Three (3) or more years of multi-specialty procedure coding experience. A variety of experience in some combination of CV Surgery, General Surgery, GI, Orthopedics, Neurosurgery, and/or Pain Management, is preferred. Specific experience in Evaluation & Management is a must. C. Licenses, Registrations, or Certifications • Certified Professional Coder – CPC (AAPC) • Certified Professional Medical Auditor – CPMA (AAPC) • Certified Coding Specialist (CCS) (AHIMA)

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