Outpatient Complex Audit Specialist/Full Time/Remote

MedStar Health; Grand Blanc (MI); Remote; USD 55,000 - 80,000; Full time

Job summary

A leading company in healthcare seeks an outpatient complex audit specialist to ensure the quality and completeness of medical record documentation for outpatient encounters. The role requires coding expertise and familiarity with medical terminologies, with responsibilities including audits and compiling educational resources to support provider performance.

Qualifications

• Minimum two (2) years coding experience required.
• Proficient in ICD-10 CM, CPT, HCC coding.
• Must have strong knowledge of medical terminology.

Responsibilities

• Responsible for audits of medical record documentation.
• Utilize coding expertise for various outpatient encounters.
• Compile an OP CDI Education database.

Skills

Organizational Skills

Time Management

Medical Terminology

Pattern Recognition

Education

High school diploma or G.E.D.

Two years coding experience

Additional specialty coding certification

One to two years college coursework in Healthcare Administration

Job description

Under the direction of the Outpatient Audit, Analytics & Technology Supervisor, in conjunction with OP Audit Analysts and Coordinators will utilize documentation and coding expertise to facilitate audits of the quality and completeness of medical record documentation for outpatient encounters, including but not limited to clinic visits, outpatient surgical procedures, telemedicine, and other ancillary services. Through concurrent, prospective and retrospective evaluation and assimilation of the medical record, the OP Audit - outpatient complex audit specialist will be responsible for utilizing knowledge of Local, State and Federal coding guidelines and regulations, NCCI Edits, ICD-10CM, CPT, Hierarchical Condition Categories (HCC), standards of compliance, and clinical knowledge to accurately abstract information from the electronic health record for compilation of an OP CDI Education database, which supports the Documentation & Coding Provider Education Program, data-driven resourcing, monthly provider performance scorecards, revenue cycle projects, KPI metric dashboards, and administrative decision making related to Revenue Cycle.

EDUCATION AND EXPERIENCE:

• High school diploma or G.E.D. equivalent required.


• Minimum of two (2) years coding experience required.


• Additional specialty coding certification or 5-7 years coding experience required.


• Prior experience in a healthcare revenue cycle position required. Specialty coding experience preferred.


• One to two (1-2) years college or additional course work in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.


• Must have through knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems.


• Strong organizational and time management skills required to effectively prioritize work.


• Ability to communicate effectively with colleagues, supervisor, and manager.


• Ability to work independently. Ability to work remotely.


• Proficient in medical terminology.


• Proficient in ICD-10 CM, CPT, HCC and HCPCS coding.


• Able to recognize patterns and trends and escalate to supervisors to support root cause analysis.


• Able to assist other team members.

Additional Information

• Organization: Corporate Services


• Department: Ascension RC Admin


• Shift: Day Job


• Union Code: Not Applicable