Senior-level professional with in-depth professional or hospital outpatient documentation, coding, and billing auditing experience within a workplace culture that emphasizes open communication and opportunities for growth. Must be highly organized and possess professional or outpatient coding certifications with specific experience reviewing documentation, coding and billing of physician charges. The ideal candidate can work independently in a home office setting, is a problem-solver and effective communicator, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.
Responsibilities
- Utilizing their knowledge of professional and/or outpatient coding, conducts compliance related documentation, coding, and billing audits to identify coding and/or clinical documentation improvement opportunities using professional coding standards and regulatory guidance.
- Applies comprehensive knowledge of Medicare and Medicaid guidelines under the Medicare Physician Fee Schedule, Conditions of Participation, state healthcare regulations, and official coding guidelines for ICD-10-CM and CPT to compliance audits.
- Demonstrates expertise in utilizing regulatory coding resources such as AMA E/M guidelines, CPT Assistant, NCCI, and Coding Clinics relative to physician charges.
- Prepares accurate and thorough claim review finding workpapers, with notation of regulatory documentation references utilized to support findings during the audit, while also maintaining greater than 95% accuracy of physician charges.
- Demonstrates an ability to collaborate well with others on the review team, sharing insights and uncovering opportunities and/or compliance risk.
- Conducts research surrounding governmental or third-party payer guidelines by evaluating applicable coding guidelines, LCD’s, NCD’s and any applicable CMS or payer guidelines. Ability to articulate research findings in a cohesive, well written manner for ease of client interpretation.
- Assists with the development of educational material and conducts education with clients on clinical documentation and professional and technical charge capture and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.
- Conducts reviews to assess the accuracy of professional and technical CDM for services requiring CPT/HCPCS codes, to include compliance with governmental guidelines and regulations.