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Certified Professional Medical Auditor Job in Chillicothe, Ohio

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Job Title: Certified Professional Medical Auditor

Employer:Adena Health System
Type:FULL TIME
Specialties:Multi-specialty physician group to include E&M, General Surgery, Ortho, Cardiology, Rad/Onc, Neurology, Nephrology and more!
Required Certifications:CPMA - NO to CPC-A,CPC
Required Experience:3 to 4 years
Location:272 Hospital Road Chillicothe 45601, OH, US
Date Posted:3/4/2020

Position Summary 

Position: Certified Professional Medical Auditor

Status: Full-time (100%/40 hours per week)

Schedule: Monday through Friday, 8am to 5pm

Location: Adena Regional Medical Center, 272 Hospital Road, Chillicothe, OH 45601

Note 1:  This is not a remote coding opportunity.  The ideal candidate will reside within a reasonable commuting distance. 

Note 2:  The position may be available in a remote setting upon completion of coding competency and 95% percent coding accuracy audit rate.

 

This position performs professional coding and abstracting functions of professional fee encounters for providers in our multi-specialty group.  The coder assigns appropriate CPT, ICD-10 and HCPCS code based on reading the documentation present in the medical record.  The coder will apply their knowledge of correct coding guidelines as appropriate for professional services performed in the outpatient and inpatient setting.  The coder will apply appropriate CPT modifiers for professional coding to call CPT codes as necessary.  Reviews medical records for diagnoses that meet medical necessity according to the CMS Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) guidelines.  Provides guidance and support for clinics to ensure compliant coding and documentation practices are followed in accordance with CMS rules and regulations.    Recognizes when it is necessary to obtain further clarification from providers when documentation is inadequate or unclear for coding purposes.  Works directly with the billing department to prevent denials and ensure revenue integrity. Provides support for providers to ensure charge capture of CMS quality payment incentive programs.  This position may be available in a remote setting upon completion of coding competency and 90% coding accuracy audit rate.

 

Duties/Responsibilities

Demonstrates thorough understanding of Cardiology ICD, CPT, HCPCS, utilize and apply all applicable modifier coding rules, EM coding and auditing as well as medical terminology and physician coding reimbursement.

Demonstrates proficiency as an educational resource to others in sharing knowledge and providing direction within the scope of the job maintaining a comprehensive and current level of knowledge of new developments and issues related to coding and reimbursement in the healthcare environment.

Strong organizational skills with ability to meet timelines.

Ability to work independently as well as with a team.

Must be able to proactively and appropriately communicate with specialty providers to clarify diagnosis and procedures.

Reviews clinical documentation to insure accurate ICD, CPT, HCPCS code assignment and appropriate reimbursement in accordance with all coding, Medicare/Medicaid and other payer specific guidelines for specialty.

Documents and/or reviews all data collected, identifying all coding and documentation errors, including working payer denial reports and ensure corrective action is taken.

Ability to successfully pass basic coding competency testing and quarterly QA audits.

Continuous education and maintaining of annual CEU’s and Certifications in assigned specialties.

Position Specific Knowledge, Skills and Abilities

Knowledge of medical terminology and Anatomy & Physiology, ICD, CPT and HCPCS codes and basic computer skills.               

Ability to prioritize work to meet timelines.

Knowledge of Cardiology and Cardiovascular coding, billing and documentation.                                                                                                                               

Minimum/Required Qualifications

High School Diploma or GED

Current CPC – Certified Professional Coder; CPC-A – Certified Professional Coder Apprentice status through AAPC – American Academy of Professional Coders; OR CCS – Certified Coding Specialist; CCS-P – Certified Coding Specialist Physician based or RHIT – Registered Health Information Technician through AHIMA – American Health Information Management Association.

Additional certifications in designated specialty specific area

3-5 years of experience coding in the assigned specialty area (example: CIRCC, CPMA, CCCS, COBGC etc.)

Preferred Qualifications

HCC coding experience

Experience with Microsoft Word, Excel and Encoders.

3-4 years of experience in Auditing

 

 


Applying

To apply through the Adena Health System Careers site use the following web address:  https://pm.healthcaresource.com/cs/adena/#/job/1472

Or contact Rick Henson at rhenson2@adena.org for additional information.

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