Serves in a consulting
role by evaluating the work of client’s coder and providers in their assignment
of ICD-10, CPT and/or HCPCS codes for professional services. Performs
concurrent or retrospective reviews to inventory code assignments and report
the data to the client. Develops and delivers educational content
to clients related to audit findings.
Essential Functions:
·
Conduct
high quality audits for both hospital owned and physician owned practices as it
relates to the ambulatory setting or professional services rendered in hospital
settings.
·
Responsible
for auditing and providing constructive feedback to clients.
o Reviews patient charts and makes
recommendations regarding coding, documentation, and reimbursement to identify
errors and inconsistencies, under coded and up coded services as recognized by
the AHA, CMS, AMA, AHIMA, Coding Clinic, and CPT Assistant.
·
Analyze
findings and identify potential root causes of produced errors.
·
Prepare
summary reports of findings to clients, supplying specific references
supporting findings contained within the provided audit report.
·
Responsible
for delivering the healthcare education programs related to professional
services and practice management to include creation of training programs for
physicians, mid-level providers, practice managers and staff of physician and
hospital owned ambulatory services.
·
Educational
focus will evolve and adjust depending upon the needs of the client and may
relate to ICD-10, CPT, HCPCS, 95, 97 and 2021 Guidelines.
·
Conduct
Audits as assigned meeting the productivity standards as set by record type for
each audit. The threshold for billable productive hours, when client work is
available, is expected to be at or above 80%.
·
Conduct
independent QA of their assigned audit results prior to final submission for QA
review and approval. The minimum accuracy expectation is 95%.
·
In
all situations, protect the privacy and confidentiality of patient health and
client information, and follow the Standards of Ethical Coding as set forth by
AHIMA and adhere to official coding guidelines and compliance practices,
standards, and procedures.
·
Possesses
the ability to discuss and clarify questions related to documentation, patient
clinical needs and related coding with providers.
Essential Duties and
Responsibilities
·
Prepare
deliverables for the client as required
·
Excellent
communication and presentation skills
·
Excellent
time management skills with ability to work independently and know when to seek
support from supervisors
·
Very
flexible, efficient, and able to perform effectively in stressful
situations.
·
Manage
a section of work from simple to complex. Understand the scope of the
total project
·
Ability
to effectively manage more than one assignment at a time and organize and
prioritize work to meet client needs and timelines
·
Report
work time and work products in a timely and accurate manner
·
Communicates
with coworkers in an open and respectful manner that promotes teamwork and
knowledge sharing
·
Interact
with clients in a professional manner that, at all times, exhibits excellent
relationship, work performance and communication skill so as to support the
company and its business interests
·
Provide
schedule of planned work activities, events and sites, and any changes to same,
to Management and appropriate staff
·
Maintenance
of professional credentials and knowledge of coding, reimbursement, and compliance
issues through continuing education.
·
Periodic
travel, as required.
·
Other
duties and responsibilities, as assigned.
Desired Minimum Qualifications
·
5+
years’ experience coding and/or auditing in an acute care facility or clinic,
of patient types listed in the Job Summary of this document, or other relevant
experience.
·
Recognized
coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered.
•
Experience with telecommuting and electronic medical record systems strongly
preferred.
•
Ability to work with multiple and diverse clients and projects
•
Possess extensive knowledge of medical and health care policies and
processes
•
Effective command over verbal and written communication with good interpersonal
skills.
•
Ability to train and mentor
others
•
Strong team and collaborative
skills
•
Strong supervisory, organizational and management background
related to physician practice
management
•
Proficient computer skills, specifically Microsoft Office products.