CAREER OPPORTUNITY OFFERING:
The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Provides guidance and leadership to coding and billing management in the implementation and administration of effective systems, processes, and procedures. Performs annual performance reviews and quality assurance reviews to assess comprehension of training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards. Ability to code and a clear understanding of the coding principles and guidelines for various specialties including Neurosurgery, Intervention Radiology, ENT, General Surgery, Cardiology, Anesthesia, Emergency Department.
Job Responsibilities:
Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at HIM facility coding for both inpatient and outpatient accounts. Performs annual performance, randomized and quality assurance reviews to assess comprehension of training efforts. Also assists in CHAN and other external audits.
Educating - Assesses the educational needs of coding staff and providers that are contracted/employed and outlined in the client SOW (included Provider Education verbiage) and develops programs or researches educational resources to meet those needs. Assists with Task Force, CDE and quality department related education. Creates presentations, develops learning material, handbook and other educational materials.
Edits/Denials/Coding - Assists with edits, denials and appeals. Also assists with coding and working holds on an as needed basis.
Training - Assists with training new and existing staff. Develops all training materials and coding aids for both formal training and use by coders in daily work. Identifies coders to be cross-trained and suggests areas for training improvement. Assists in the implementation and administration of effective systems, processes, and procedures.
Coordinating - Coordinates the presentation of ongoing professional seminars and materials via audio-conferences, webinars, and other publications. Maintains education records on all staff to include attendance records for all coding related educational activities.
Resource - Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting professional coding standards. Performs miscellaneous job-related duties as assigned.
Reporting - Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW (Included Provider verbiage). Assists with the creation of various documents and reports as requested. Immediately provides reports related to compliance risks when requested.
Experience We Love:
5+ years of coding experience.
3+ years of auditing experience.
Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite.
Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
Consistently achieves quality and productivity standards.
Ability to organize and complete work in a timely manner.
Ability to read, write and effectively communicate in English.
Ability to understand medical/surgical terminology.
Above average written and verbal communication skills.
Position may require 20-40% travel to client sites.
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.
Minimum Education:
Required Certifications:
Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):
CPC (Certified Professional Coder)
CCS-P (Certified Coding Specialist-Phys Based)
CCS (Certified Coding Specialist)
CMPA (Certified Professional Medical Auditor)
RHIA (Registered Health Information Administrator)
RHIT (Registered Health Information Technician)
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