Senior Coding Quality Auditor (Remote, must live in IL, IN or WI)

Nevada System of Higher Education

69d•$27 - $40•Remote

About The Position

Conducts Retrospective Audits to ensure compliance with internal policies and procedures and existing CMS regulations; identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy is achieved. Effectively communicates the audit process and results to the appropriate departments and management. Educates leaders and staff when deficiencies in documentation and code selected are identified Develops timelines for auditing and manages auditing according to schedule. Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing is being performed in an accurate and timely manner and is supported by documentation. For all assigned records assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. Remains current on ICD-10 codes, CMS documentation requirements, and State and Federal regulations. Coordinates with Manager and Corporate Compliance Department on any compliance investigations that involve physician groups. Participates in compliance investigations, as needed Attends Internal and External education programs/conferences in order to support continuous improvement, career growth and development. Encourages professional membership in the American Academy of Professional Coders (AAPC) or American Health Information Management (AHIMA).

Requirements

High School Diploma
Strong analytical, problem solving, interpersonal, verbal/written communication, organizational and team development skills are necessary.
Knowledge of Microsoft Office Suite - Proficient in PC skills including Microsoft Excel, Power Point and Word.
Ability to interact with all levels of health care team professionally.
Ability to write correspondence proficiently and to communicate in a professional manner and effectively handles difficult situations and/or individuals objectively.
3 years coding and auditing experience.
5 years experience working in a hospital or clinical setting
CPC or CCS-P required

Responsibilities

Conducts Retrospective Audits to ensure compliance with internal policies and procedures and existing CMS regulations
Identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy is achieved.
Effectively communicates the audit process and results to the appropriate departments and management.
Educates leaders and staff when deficiencies in documentation and code selected are identified
Develops timelines for auditing and manages auditing according to schedule.
Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing is being performed in an accurate and timely manner and is supported by documentation.
Assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
Remains current on ICD-10 codes, CMS documentation requirements, and State and Federal regulations.
Coordinates with Manager and Corporate Compliance Department on any compliance investigations that involve physician groups.
Participates in compliance investigations, as needed
Attends Internal and External education programs/conferences in order to support continuous improvement, career growth and development.
Encourages professional membership in the American Academy of Professional Coders (AAPC) or American Health Information Management (AHIMA).