Provider Consultant

Health Information Associates (HIA); Pawleys Island (SC); Remote; USD 60,000 - 85,000; Full time

Job summary

A health services firm in Pawleys Island seeks a candidate to perform compliance audits, focusing on CMS, CPT, and ICD-10 guidelines. This role involves reviewing records for accuracy, conducting educational summation conferences with clients, and maintaining communication throughout the review process. Ideal applicants should have a high school diploma coupled with an AAPC credential and a minimum of 5 years' experience in a multispecialty clinic. Strong communication, organizational, and critical thinking skills are essential for success in this position.

Qualifications

• At least one AAPC credential; CPC preferred.
• Minimum 5 years review experience in a multispecialty clinic/facility.
• ICD-10-CM training.

Responsibilities

• Prepares for Review and ensures appropriate diagnosis reporting.
• Reviews records to ensure compliance with federal and state guidelines.
• Conducts Summation Conference with Administration and staff.

Skills

Computer proficiency

Communication skills

Organizational skills

Critical thinking

Ability to work independently

Education

High School diploma

AAPC credential (CPC preferred)

Tools

Electronic Health Record (EHR)

Review databases (Intelicode, MD Audit)

Job description

Overview

Performs compliance audits based on current CMS, CPT, ICD-10 guidelines, as well as all state and federal regulations. Utilizes the CMS 95/97 or 2021 documentation guidelines for evaluation and management (E&M) reviews. Writes and presents concise recommendation worksheets with appropriate findings and references to clients during summation calls. Writes Executive Summaries and must communicate with different levels within the practice/facility. Utilizes review databases (Intelicode, MD Audit, etc).

Required Skills and Experience

• High School diploma with at least one AAPC credential; CPC preferred
• Minimum 5 years review experience in a multispecialty clinic/facility
• ICD-10-CM training
• Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources
• Experience using Electronic Health Record (EHR)
• Independent, focused individual able to work remotely
• Sound organizational, communication and critical thinking skills

Responsibilities

• Prepares for Review
• Reviews Evaluation and Management codes based on CMS 95/97 or 2021 Documentation Guidelines
• Reviews records assigned to ensure appropriate diagnosis reporting based on ICD-10-CM Guidelines (addition, deletion, revision, re-sequence)
• Reviews records assigned to ensure appropriate CPT reporting based on CPT coding conventions
• Reviews record for documentation opportunities and compliance issues based on Federal and State guidelines and/or Payor requirements
• List out findings with recommendations from guidelines/regulations (CMS Documentation Guidelines, Coding Clinic, Federal Regulations, CMS Physician Services Guidelines, etc.) to provider client with educational feedback for corrective action
• Research State/Federal and/or Payor guidelines to support recommendations made
• Uses various software applications, groupers, encoders and other coding tools to analyze and ensure appropriate codes, sequencing and edits
• Runs preliminary and final reports as required
• Completes client rebuttals and makes appropriate changes in database as needed
• Prepares for Summation Conference using Teams
• Conducts Summation Conference with Administration
• Conducts Summation Conference with staff and or providers as requested

Client Relations

• Maintains adequate communication with client throughout the review process to ensure review goals and objectives are met
• Leads organized summation conference in an approachable, educational manner for client staff
• Provides ongoing educational support to client staff between scheduled reviews by researching issues and responding promptly to client inquiries
• Maintains strict confidentiality and adheres to HIPAA guidelines
• Exhibits professional demeanor at all times
• Maintains communication by responding promptly to Corporate office staff
• Demonstrates flexibility, open mindedness, and versatility in adjusting to changing environments
• Handles constructive feedback with a positive attitude
• Receptive to suggestions for changing or improving the way work is accomplished
• Commits to continually improving his/her job skills (i.e. attends educational meetings)