Job description
MAHEC's Department of Risk and Compliance is seeking an experienced Compliance Auditor / Provider Educator. This role is responsible for internal quality assessment reviews on provider coding and documentation to ensure compliance with national coding guidelines and MAHEC policies for complete, accurate, timely and consistent coding. This results in appropriate reimbursement and data integrity. This role will train in person and remote/hybrid work environment will be available after the initial training period.
SPECIFIC RESPONSIBILITIES:
Auditing - Medical Coding
- Conducts quality assessment reviews as pre-billing audits and include outpatient, inpatient, and surgical records.
- Collaborates with the Clinical Business Office (CBO) Director and Business Office Manager to review and educate the coding team to improve accuracy, integrity and quality of patient data to ensure minimal variation in coding practices.
- Develops internal audit plan in collaboration with the Compliance Officer.
- Complete service based audits as needed.
- Performs pre-billing and procedure audits of evaluation and management services for patient encounters by utilizing national coding and payer specific guidelines to ensure accuracy of diagnosis codes and provider documentation; track accuracy and trend data to identify areas for improvement.
- Provides technical guidance and education to providers in identifying and resolving issues or errors.
- Reviews claim denials pertaining to coding and medical necessity issues and collaborates with key stakeholders to implement corrective actions to include education or workflow changes.
- Develops quality audit reports that analyze the data, identify trends/opportunities and proposes strategies for resolution and educational opportunities.
- Stays current of coding, compliance and billing requirements by various government/regulatory agencies and payors to effectively apply this knowledge to complex coding, quality and compliance situations.
- In collaboration with the Compliance Officer, helps facilitate external pre-billing audits conducted throughout the year, including but not limited to, identifying and suspending encounters, reviewing external auditor responses, follow-up with external auditor and provider education.
- Engages in proactive thinking by recommending actions for improving coding compliance or workflow improvement opportunities.
Provider/Learner Education - Medical Coding
- Provides provider education based on the quality monitoring review findings and trends.
- Orients new Residents and other Learners as needed to appropriate medical coding practices.
- Assists physicians and other providers with coding presentations as needed.
- Meets with Residents/Learners on a regular schedule and individually on an as needed basis to review completeness and appropriateness of patient encounter documentation in compliance with coding guidelines.
- Education for new providers during their orientation process to ensure understanding of MAHEC billing and coding practices
- Responds in a timely manner to inquiries from other departments regarding patient charges, appropriate diagnosis coding and other coding questions related to the revenue cycle.
- Serves as a resource for department managers, staff, providers and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements and new coding initiatives.
- Maintains open dialogue, promotes collaboration and good working relationships with all members actively engaged in the Revenue Cycle at MAHEC.
KEY COMPETENCIES:
Communication Skills
- Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.
Decision Making
- Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.
HealthCare Knowledge
- Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.
Interpersonal Skills
- Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.
Organizational Values
- Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.
Problem Solving
- Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically.
SPECIFIED SKILLS
COMPUTER
- Must have advanced computer skills including Microsoft Office Suite.
- Allscripts PM/EMR Pro software experience preferred.
EDUCATION AND EXPERIENCE
MINIMUM QUALIFICATIONS:
- Three (3) years of medical coding and auditing experience.
- Proficient use and extensive working knowledge of billing procedures, application and use of ICD-10, CPT and modifiers using professional coding guidelines consistent with CMS compliance and other federal regulations.
PREFERRED QUALIFICATIONS:
- Federally Qualified Healthcare Organization (FQHC) experience.
- Allscripts PM/EMR Pro software experience.
REQUIRED CERTIFICATION:
- Certified Professional Coder (CPC) and or Certified Coding Specialist (CCS) through an accredited certification board such as AAPC and or AHIMA.
DESIRED CERTIFICATION:
- Certified Professional Medical Auditor (CPMA).
- Certified Risk Adjustment Coder (CRC).
SCHEDULE:
- Regular attendance on-site is an essential function of this position. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend, holiday, or evening coverage is occasionally required. Work hours will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader. A Hybrid-Remote Schedule is an option after employee is adequately trained.
Throughout the COVID-19 pandemic, MAHEC has worked tirelessly to promote evidence-based practices across our entire organization. With this in mind, all MAHEC employees and learners will be required to receive the COVID-19 vaccine or have an approved exemption.
MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer. Black, Indigenous, People of Color and Spanish/English bilingual persons are strongly encouraged to apply. With this in mind, studies show that women, gender diverse, and BIPOC candidates are less likely to apply unless they meet all of the qualifications listed in the job description. If you are interested in this role, and you have related experience and qualifications, we encourage you to apply or reach out to AskTalent@mahec.net for support in your job search process. You could be the talent we are seeking for this or other opportunities.
MAHEC is a certified Living Wage employer through Just Economics of Western North Carolina. We offer excellent benefits and are committed to creating a diverse, inclusive, and equitable workplace.
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