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Senior Coding Auditor

1 month ago

Queen Creek, United States Quadris Team LLC Full time
Job DescriptionJob Description

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for a dynamic person to join us, working with our Medical Coding Team to fill the role of Senior Coding Auditor. We are a 100% remote team supporting our clients across the United States See us at www.quadristeam.com We are looking for high performing, passionate and results driven team members to join our group.

Job Focus:

The Senior Coding Auditor may be responsible for a variety of duties and obligations, depending on the client and assignment. These responsibilities may include inpatient/outpatient/professional fee facility auditing, denial management, coding, implementation specialist, job aid creation, training, and specialty coding. The position may also be responsible for management of the audit team and project management. All coding and auditing are performed within the scope of regulatory and compliance law expectations.

Auditing Responsibilities:

May include conducting inpatient, outpatient and pro fee coding audits and provides educational programs both internally and externally based on audit results. Effectively uses abstracting databases, internal and external audit results, QIO reports and revenue cycle edit/denial information to identify audit populations. Effectively interacts with both coding staff and different levels of management within Quadris and with our client leadership teams. This individual must demonstrate a commitment to the organization's strategic plans, short and long-term goals and mission, vision, and values by representing the company in a caring and professional manner.

Primary/Essential Expectations For Success:

  • Knowledge of inpatient facility coding including MS-DRG, APR-DRG, HAC, Core Measure, risk qualifiers and quality documentation
  • Knowledge of outpatient facility coding including CPT, ICD10, HCPCS, modifier application, APC, NCCI edits
  • Knowledge of professional fee coding including E&M assignment, CPT, ICD10, modifier application
  • Extensive understanding of various reimbursement methodologies
  • Conducts ongoing record audits to verify coding and grouping accuracy
  • Identifies documentation improvement opportunities, CDI certification a plus
  • Performs educational sessions for coding specialists, client leadership teams and physicians when requested
  • Reports on coding and grouping accuracy based on audit results
  • Serves as an expert resource for all coding staff
  • Utilizes technical coding expertise to review the medical record thoroughly, utilizing all available documentation for abstracting and review
  • Follows Official Coding Guidelines and rules to assign and evaluate appropriate codes
  • Provides documentation feedback to client and or account manager
  • Maintains coding reference information
  • Reviews and communicates new or revised billing and coding guidelines and information with providers and their assigned specialty
  • Resolves pre-accounts receivable edits. Identifies and reports repetitive documentation problems as well as system issues
  • Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate
  • May collaborate with Patient Accounting, and other operational areas to provide coding reimbursement assistance; helps identify and resolve incorrect claim issues and may assist with drafting letters to coordinate appeals
  • May work with Revenue Cycle staff and Account Inquiry Unit staff as requested, assists in obtaining documentation (notes, operative reports, etc.). Provides additional code and modifier information
  • Meets established minimum coding productivity and quality standards for each encounter type based on type of service coded
  • May perform other duties as assigned

Physical/Mental Demands, Environment:

  • Prolonged periods of sitting at a desk and working on a computer
  • Must be able to lift 15 pounds at one time
  • Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations

Skills Needed to Be Successful:

  • Ability to accurately sequence diagnosis and procedures
  • Ability to identify areas of opportunity for documentation improvement, code assignment, data integrity and education
  • Ability to provide guidance to other departmental staff in identifying and resolving coding issues or errors
  • Ability to analyze and resolve claim denials that are rejected by edits from the Patient Accounts department
  • Ability to maintain the national standards for coding accuracy and internal standards for productivity
  • Maintains compliance with regulations and laws applicable to job
  • Professional level of communication with video, phone, and email
  • Ability to effectively prioritize the work to meet deadlines and expectations
  • Meets the quality and productivity measures as outlined by Quadris
  • Brings positive energy to work
  • Uses critical thinking skills
  • Being present and focused on assigned tasks and eliminates distractions
  • Being a self-starter
  • Ability to work independently and within a team atmosphere

Core Talent Essentials:

  • High School diploma or equivalent
  • Required AHIMA certification, CDI certification a plus
  • 5+ years of experience in healthcare medical coding; Inpatient experience required
  • 1+ years of experience in inpatient auditing
  • Ability to work independently and within a team atmosphere
  • Advanced and proficient knowledge of all coding concepts
  • Self-motivated and passionate about our mission and values of quality work
  • Must have professional level skills in MS products such as Excel, Word, Power Point.
  • Must be able to type proficiently and with an effective pace
  • Proficient application of business/office standard processes and technical applications