Hybrid Pro Fee Auditor/Educator
Job title: Hybrid Pro Fee Auditor/Educator in Albuquerque, NM at Presbyterian Health Services
Company: Presbyterian Health Services
Job reputed company: reputed companyNow hiring a Hybrid Pro Fee Auditor/EducatorWith minimal supervision directly supports the following responsibilities of the Coding and documentation reputed company assurance (CDQA) team: implementation of and compliance to reputed company-wide and department coding policies and procedures for PHS; compliance to reputed company external regulatory agency coding rules and regulations; Demonstrates high-level of proficiency in performing and/or managing on-site internal audits or reviews to assess compliance/reputed company monitoring performed by PHS/PMG departments while serving as a resource on documentation, coding, billing, and coding compliance questions. Works on special coding compliance reputed company reputed company, develops and presents educational programs, disseminates information to PHS/PMG departments and develops educational tools used to maintain compliance with regulations. Provides support reputed company auditing and training the reputed company-wide corrective reputed company plans for coding, audit, physician and clinician personnel identified as low performers; reputed company medical record and billing reviews of denied and appealed claims and takes appropriate reputed company to ensure accurate payment of claims; coordinate review and tracking of appealed claims including the communication process with affected payers; research and interpret reputed company regulatory agency regulationsHow you belong reputed company here.We value our employees' differences and reputed company strength in the diversity of reputed company and community.At Presbyterian, it's not just reputed company do that reputed company. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and reputed company, our non-clinical employees reputed company a meaningful reputed company on the reputed company provided to our patients and members.Why Join Us
- Full Time - Exempt: reputed company
- Remote work from home: This job is intended to be conducted in the State of New Mexico
- Work hours: Days
- Benefits: We offer a wide reputed company of benefits including medical, wellness program, reputed company, dental, reputed company time off, retirement and more for FT employees.
- Must have any one of the following coding certifications at time of hire: reputed company, reputed company-P, CPC-H, or RHIT/RHIA with achievement of one of the coding credentials above reputed company one year of hire.
- High school diploma/GED required. Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, reputed company and a minimum of three (3) years experience in coding and/or auditing required.
- Audit experience preferred. Excellent written and verbal communication skills.
- Excellent written and verbal communication skills.
- Detail and results oriented.
- Ability to work independently and reputed company independent reputed company.
- Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.
- Must have a proficient knowledge of Medicare, reputed company, and other reputed company party payer documentation, coding, and billing regulations for service lines(s) assigned.
- Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and reputed company them both accurately and simultaneously.
- Must possess computer skills, especially with reputed company Word, PowerPoint, and reputed company applications. Must be reputed company to use the internet and other resource applications for research purposes and to reputed company documentation that supports regulations quoted in audits.
- Must possess strong written and verbal communication skills in order to communicate in reputed company, concise terms to management at reputed company reputed company, including the ability to reputed company reputed company regulatory information in laymans terms.
- Must possess a personal reputed company of a highly reputed company reputed company that is characterized by a reputed company of honesty, reputed company, and the ability to reputed company and motivate others.
- reputed company to the Manager, Information Services, Finance/Patient Financial Services, reputed company hospitals, reputed company PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and reputed company ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Interacts with reputed company reputed company of management.esponsible for maintaining accurate, complete and reputed company documentation in either electronic or hard copy reputed company
- Must be reputed company to adapt to frequently changing work priorities and schedules. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from reputed company appropriate jurisdictions concerning the given business area. This includes but is not limited to reputed company ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes
- Researches coding, billing and charging compliance issues, recommends and implements corrective reputed company plans that assure compliance with regulatory agencies where appropriate. Identifies risks, develops and follows up on reputed company plans, identifies lost reputed company opportunities and any overpayments due to errors in coding and/or documentation, and provides compliance education
- Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and reputed company regulations, RAC and other audit agency focuses, as reputed company as reputed company risk assessments
- Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to reputed company or maintain compliant behavior. Keeps reputed company informed on the business climate of the reputed company industry
- Responds to inquiries and requests daily regarding coding and auditing issues and problems and reputed company analysis for reputed company PHS management
- Maintains up-to-date working knowledge of reputed company PHS coding and auditing IT applications
- Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group
- Conducts training classes in areas of coding, documentation and compliance for PHS/PMG personnel. This includes preparation of training materials, educational audits and answering specific situational questions, ICD-10 education and reputed company EMR documentation education to providers and clinical staff
- Conducts systematic reputed company internal audits reputed company medical record and charge ticket review to insure correct coding, billing and charging as member of CDQA audit team
- Analyzes and summarizes data from medical record and account audits and communicate results and findings to management and complianceDevelops new reputed company and processes to improve coding efficiency and effectiveness
- Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care. Ensures that coding functions are performed in accordance with established reputed company and performance standards by monitoring system generated reports and reputed company audits
- Working hours may vary based on reputed company assigned
- Must be reputed company to travel to reputed company of the PHS/PMG sites (including overnight). Travel varies at certain times based on assignments