CDQA Administrative Analyst

0090 Presbyterian System Services; New Mexico; Hybrid; USD 27,000 - 44,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

Wellness program

Job summary

Presbyterian Healthcare Services is hiring for a CDQA Administrative Analyst to support the Enterprise-Wide Coding team. Under supervision, you will update coding policies, monitor regulatory compliance, and coordinate audits across PHS departments.

You will also assist with training, documentation, and data analysis to improve coding accuracy and resolve billing issues, working remotely across New Mexico with regular interaction with management and staff.

Qualifications

• High school diploma or GED required.
• One year healthcare clinical, coding, auditing, compliance, or patient financial services experience.
• Excellent written and verbal communication skills.
• Detail- and results-oriented; ability to work independently.
• Knowledge of ICD-9/10, CPT-4 and HCPCS recommended.

Responsibilities

• Liaison to multiple departments and sites to address coding, auditing, compliance and training issues.
• Maintain accurate, complete and timely documentation in electronic or hard copy form.
• Keep up-to-date with regulatory information and coding changes (ICD-9/10, CPT-4, HCPCS).
• Research coding, billing and compliance issues and implement corrective action plans.
• Respond to inquiries daily via telephone and email; provide ad-hoc analyses for management.

Skills

Excellent communication

Detail oriented

Independent worker

Education

High School Diploma

Job description

Location Address

Remote Office Santa Fe, NM 87501

Compensation Pay Range

Minimum Offer $19.25 Maximum Offer $31.74

Now Hiring

CDQA Administrative Analyst

Summary

With supervision, directly supports the following responsibilities of the Enterprise-Wide Coding team: maintain and update enterprise-wide and department coding policies and procedures for PHS; monitor compliance to all external regulatory agency coding rules and regulations; coordinate internal and external enterprise-wide coding audits for all areas within PHS conducting coding; summarize and track internal and external audit results for all of PHS; coordinate and track enterprise-wide training of all PHS coding, audit, physician and clinician personnel; support via tracking the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; perform medical record and billing reviews of denied and appealed claims with assistance of coder and clinical auditors; compile and analyze Enterprise-Wide Coding scorecard metrics for coding related denials and appeals and overall coding accuracy results based on both internal and external audits; research regulatory agency regulations; correct patient accounts based on internal and external audit findings.

Type of Opportunity

Full time

Job Exempt

No

Job is based

Remote Workers

Work Shift

Days (United States of America)

Responsibilities

Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, CPT-4, HCPCS and APC updates and changes. Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management. Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group. Responds to client problems and inquiries via the telephone and e-mail. Maintains up-to-date working knowledge of all PHS coding and auditing IT applications. Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care. Analyzes and summarizes data from medical record and account audits and communicate results and findings to management. Documents via information systems the responses and resolutions to both internal and external customer inquiries and issues to ensure high quality and standardized responses as well as tracking and reporting capability. Provide assistance in audit research and documentation.

Qualifications

High school diploma/GED required. One year healthcare clinical, coding, auditing, compliance or patient financial services related experience. Excellent written and verbal communication skills. Detail and results oriented. Ability to work independently. Medical terminology, ICD-9/10, CPT-4 and HCPCS knowledge required.

All benefits-eligible

Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well‑being. Earn gift cards and more by taking an active role in our personal well‑being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Equality, Diversity, and Inclusion

AA/EOE/VET/DISABLED.

Employer Policies

PHS is a drug-free and tobacco-free employer with smoke free campuses.

We’re Determined to Support New Mexico’s Well-Being | Presbyterian Healthcare Services

Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.