Hybrid Pro Fee Auditor/Educator

Presbyterian Healthcare Services; Albuquerque (NM); Hybrid; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a Hybrid Pro Fee Auditor/Educator to enhance coding compliance and documentation quality. This role involves auditing, training, and ensuring adherence to regulatory standards while collaborating with multiple departments. The ideal candidate will possess strong coding certifications and experience, alongside excellent communication skills. Join a dedicated team committed to improving healthcare quality and compliance, where your expertise will make a significant impact on patient care and operational excellence. Embrace the opportunity to grow in a supportive environment that values diversity and personal well-being.

Benefits

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement plan

Wellness program

Qualifications

• Must have coding certifications and three years of experience in coding/auditing.
• Audit experience preferred with strong communication skills.

Responsibilities

• Liaison to various departments addressing coding, auditing, and compliance issues.
• Conduct training classes in coding, documentation, and compliance.

Skills

Coding compliance

Auditing

Medical terminology

Communication skills

Detail-oriented

Decision-making

Education

High school diploma/GED

Coding certifications (CCS, CCS-P, CPC-H, RHIT/RHIA)

Tools

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

Job description

Overview

Now hiring a Hybrid Pro Fee Auditor/Educator.

With minimal supervision, directly supports the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS; compliance to all external regulatory agency coding rules and regulations. Demonstrates a high level of proficiency in performing and/or managing on-site internal audits or reviews to assess compliance/quality monitoring performed by PHS/PMG departments while serving as a resource on documentation, coding, billing, and coding compliance questions. Works on special coding compliance-related projects, develops and presents educational programs, disseminates information to PHS/PMG departments, and develops educational tools used to maintain compliance with regulations. Provides support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician, and clinician personnel identified as low performers; performs medical record and billing reviews of denied and appealed claims and takes appropriate action to ensure accurate payment of claims; coordinates review and tracking of appealed claims including the communication process with affected payers; researches and interprets all regulatory agency regulations.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• 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 range of benefits including medical, wellness program, vision, dental, paid time off, retirement, and more for FT employees.

Ideal Candidate:

• Must have any one of the following coding certifications at the time of hire: CCS, CCS-P, CPC-H, or RHIT/RHIA with achievement of one of the coding credentials above within one year of hire. Three to five years of experience as a coder required.

Qualifications

• High school diploma/GED required. Must possess at least one of the following licenses/certifications: RHIT, RHIA, CPC, CCS and a minimum of three (3) years experience in coding and/or auditing required.
• Audit experience preferred. Excellent written and verbal communication skills.
• Detail and results oriented.
• Ability to work independently and make independent decisions.
• Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.
• Must have proficient knowledge of Medicare, Medicaid, and other third-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 perform them both accurately and simultaneously.
• Must possess computer skills, especially with Microsoft Word, PowerPoint, and Excel applications. Must be able to use the internet and other resource applications for research purposes and to provide documentation that supports regulations quoted in audits.
• Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in layman's terms.
• Must possess a personal presence of a highly qualified professional that is characterized by a sense of honesty, integrity, and the ability to inspire and motivate others.

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. Interacts with all levels of management.
• Responsible for maintaining accurate, complete, and timely documentation in either electronic or hard copy form.
• Must be able to adapt to frequently changing work priorities and schedules. 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, ICD-10, 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. Identifies risks, develops and follows up on action plans, identifies lost revenue 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 Medicaid regulations, RAC, and other audit agency focuses, as well as internal and external risk assessments.
• Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. Keeps actively informed on the business climate of the healthcare industry.
• Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.
• Maintains up-to-date working knowledge of all 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 EPIC EMR documentation education to providers and clinical staff.
• Conducts systematic focused internal audits via medical record and charge ticket review to ensure correct coding, billing, and charging as a member of the CDQA audit team.
• Analyzes and summarizes data from medical record and account audits and communicates results and findings to management and compliance. Develops new methods 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 quality and performance standards by monitoring system-generated reports and quality audits.
• Working hours may vary based on projects assigned.
• Must be able to travel to all of the PHS/PMG sites (including overnight). Travel varies at certain times based on assignments.

Benefits

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, webinars, preventive screenings, 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 a 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 1,600 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.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.

Maximum Offer for this position is up to

USD $38.86/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.