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Senior Auditor, Coding Quality - Remote

Company: Conifer Health Solutions
Location: Charlotte
Posted on: January 16, 2022

Job Description:

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Job Summary

The Sr. Auditor, Coding Quality conducts Initial Coding Quality Reviews (IQRs), Monthly Coding Quality Reviews (MQRs), Focused Quality Audits, and other ad hoc coding quality audits as requested to ensure hospital inpatient,outpatient , and profee claims, ICD-10-CM/PCS, and/or CPT codes were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as corporate coding compliance policies. The Senior Coding Quality Auditor's role is designed to ensure the integrity of Conifer's coding program is consistently maintained. The Senior Coding Quality Auditor will deliver written and verbal reports of findings to other Compliance department staff members, as well as hospital, region, and/or corporate operations staff as indicated. The Senior Coding Quality Auditor will escalate significant trends to the Coding Compliance team as warranted.

The Senior Auditor will also assist with coding education development, Coding Mentoring Program administration, and quality reporting. As a Coding Quality subject matter expert, the Senior Auditor will mentor and advise in the various areas of Coding Quality.

Essential Duties And Responsibilities

Include the following. Others may be assigned.

  • Understands, interprets and applies coding guidelines for coding quality audits. Audits inpatient, outpatient, and profee encounters with complex code assignments. Review of complex medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM//PCS codes, MS-DRGs, APR-DRGs, CPT's, APC's, and discharge disposition which all impact facility reimbursement and RVUs which impact profee reimbursement.
  • Performs ad hoc coding quality audits; coordinates prebill audits, IQRs, and MQRs; coordinates and develops educational sessions; assists with creation of client and vendor reports; assists with training new auditors; coordinates and performs peer reviews; assists with tracking the completion of MQRs; assists with identifying and analyzing coder and coding trends; and performs training and coding quality auditing for Coder Mentoring Program.
  • Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
  • Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
  • Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and OPPS, ICD-10-CM and CPT updates) for inpatient, outpatient, and ProFee coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
    Supervisory Responsibilities

    If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
    • Indirect Reports (titles): Coding Quality Auditors

      Conifer requires its candidates and contractors, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

      Knowledge, Skills, Abilities

      To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
      • Ability to consistently and accurately audit complex coding of inpatient,outpatient, and pro-fee encounters
      • Ability to create clear and concise audit reports and maintain productivity standards
      • Must successfully pass pre-hire coding assessment
      • Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
      • Expert level knowledge of disease pathophysiology and drug utilization
      • Expert level knowledge of MS-DRG, APR-DRG, APC, and RVU classification and reimbursement structures
      • Expert level knowledge of APC, OCE, NCCI classification and reimbursement structures
      • Expert level knowledge of HACs, PSIs, and HCCs
      • Must be detail oriented and have the ability to work independently and in team setting
      • Computer knowledge of MS Office
      • Must display excellent interpersonal skills
      • Ability to demonstrate initiative and discipline in time management and assignment completion
      • Ability to research difficult coding and documentation issues and follow through to resolution
      • Ability to manage time effectively and prioritize assignments and projects
      • Ability to work in a virtual setting under minimal supervision
        Education / Experience

        Include minimum education, technical training, and/or experience preferred to perform the job.
        • Associates degree in relevant field preferred or combination of equivalent of education and experience
        • Five (5) years coding experience including but not limited to hospital inpatient,outpatient, and pro-fee encounters
        • Five (5) years of experience in coding quality audit work including but not limited to hospital inpatient, outpatient, and ProFee encounters
          Required Certifications/Licensure

          Include minimum certification required to perform the job.
          • AHIMA and/or AAPC Coding Credential, CCS preferred for hospital related positions and CPC or CCS-P preferred for ProFee positions

            The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
            • Must be able to work in sitting position for extended periods
            • Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone
            • Ability to travel
            • Duties may require driving an automobile to off- site locations.
            • Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
              WORK ENVIRONMENT

              The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
              • Office Work Environment
              • Hospital Work Environment
                • Approximately 15% travel may be required
                  Job: Conifer Health Solutions

                  Primary Location: Frisco, Texas

                  Job Type: Full-time

                  Shift Type: Days

Keywords: Conifer Health Solutions, Charlotte , Senior Auditor, Coding Quality - Remote, Accounting, Auditing , Charlotte, North Carolina

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