|Employer:||Coding Advantage, LLC
|Skills:||Auditing,Compliance and HCC audits
|Specialties:||Behavioral Health and Internal Medicine/Family Practice/other
|Required Experience:||5 to 7 years
|Preferred Experience:||5 to 7 years
|Location:||PO Box 691 Chardon 44024, OH, US* Note: This listing is for a remote position
Medical Auditor/HCC Specialist -Quality Control Analyst
Summary of Position:
Auditing medical charts and records for compliance
with industry standard coding guidelines, federal regulations, and various
third-party carrier guidelines. Uses knowledge and experience to quality check
as a second level other coding and auditing contractors, ensuring that all
contractors conform to policies and procedures in place for Coding Advantage,
Reviews, develops, and/or modifies our internal procedures,
systems, and protocols to achieve and maintain quality and consistency
throughout our auditing and coding engagements. This position will also provide
guidance to other auditing contractors and will enforce our internal auditing
and coding compliance standards.
Duties and Responsibilities:
medical record documentation to identify deficiencies in
documentation in direct relationship to codes billed to carriers.
Prepares reports of findings and clearly communicates the appropriate
action plans to correct identified deficiencies.
second-level review of other auditing contractors to ensure compliance
with legal and procedural policies and to ensure optimal workmanship is
delivered for our clients.
request, researches, analyzes, and responds to our client’s inquiries
regarding compliance, coding, denials, and billable services.
instructs, and/or provides technical support to auditing and coding
contractors as appropriate regarding coding compliance, documentation,
regulatory provisions, and third- party payer requirements.
develops, modifies, and/or adapts relevant procedures, protocols, and data
management systems to maintain consistency to the way we deliver reports
to our clients.
strict confidentiality of all clients and/or proprietary company
information. A non-disclosure must be signed.
coding conferences, workshops to receive updated coding information and
changes in coding and/or auditing regulations.
miscellaneous auditing and coding client-related duties as assigned.
Minimum Job Requirements
Professional Coder (CPC) and at least 3 years of
experience directly related to the duties and responsibilities specified.
Professional Medical Auditor (CPMA) and/or Certified Professional
Compliance Officer (CPCO) designation preferred.
Knowledge, Skills and Abilities Required
of auditing concepts and principles.
knowledge of medical coding and billing systems and regulatory
to use independent judgment and to manage and impart confidential
to analyze and solve problems.
communication and interpersonal skills. You must be able to be
available for Zoom meetings to discuss results with providers.
of legal, regulatory, and policy compliance issues related to medical
coding and auditing.
of current and developing issues and trends in medical coding.
written and verbal communication skills
of Excel and Adobe
knowledge of medical coding systems, procedures, and documentation requirements.
to adapt and modify procedures, protocol, and data management systems to
meet specific client needs.
to provide guidance and training to professional and technical staff in
area of expertise.
be a self-starter, able to work independently “behind the scenes” and
provide best practice approach to serving clients.