|Required Experience:||3 to 4 years
|Preferred Experience:||5 to 7 years
|Location:||700 School Street Pawucket 02860, RI, US
In the role of Evaluation and Management Auditor, you will be part of a team of dynamic leaders at PMG, a company dedicated to the successful revenue management of Federally Qualified Health Center’s (FQHC’s). This exciting position is a member of our Compliance Team, which is responsible for auditing medical records for compliance with federal coding regulations and guidelines. The Evaluation and Management Auditor main responsibility will be to conduct medical record reviews and other coding projects as assigned.
• Performing chart reviews, and coding to determine the completeness of the medical record coding and documentation.
• Assisting & maintaining department lead/management with the development of coding material, as well as provide input for provider education/reviews.
• Responsible for reporting documentation and coding trends that may impact the success of the coding reviews, at the individual provider level, as well as the organization.
• Prepares audit reports that are issued to physicians, advanced practice clinicians, leadership and other key stakeholders, as appropriate.
• Assists in the management of the coding and billing auditing and monitoring program to address high risk compliance areas.
• Interacting with client or other patient care providers regarding billing and documentation policies, procedures and regulation; obtains clarification of conflicting, ambiguous or non-specific documentation.
• Interfacing daily with all PMG Departments (including PMG Operations Team).
• Compiling notes from PMG clients sent over for their audits.
• Performing miscellaneous job-related duties as assigned.
Summary of Qualifications:
High School diploma or equivalent required. Associates and/or Bachelor’s Degree a plus. Must have CPC certification.
At least 3 years of prior Evaluation and management auditing (required) and coding experience required.
• Knowledge of medical coding and billing systems and regulatory requirements.
• Working knowledge of legal, regulatory and policy compliance issues related to medical coding and billing procedures and documentation.
• Prior knowledge of Evaluation and Management coding Guidelines.
• Proficient communicator, both verbally, interpersonally and written; ability to clearly communicate complex subject matter to professionals of various levels.
• Ability to use independent judgement and to manage and impart confidential information.
• Capable of dealing with frequent interruptions.
• Knowledge of Windows Office products (e.g. Word, Excel, Outlook, etc.), as well as understanding Medical Billing software.
Necessitates fine motor skills; occasionally requiring pushing, pulling, lifting and carrying up to 15 lbs. Must be able to use a computer, including keyboard and telephone, during peak activity periods, in excess of 7.5 hours per day and/or 37.5 hours per week. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.