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Healthcare Coding Audit Specialist

2 months ago


Alpharetta, United States CIOX Health Full time

Professional Fee Audit Specialist

Job Locations

US-Remote

Requisition ID

# of Openings

1

Category

HIM / Coding

Position Type

PRN

Equal Pay Act Minimum Range

$40.00 per hour

Overview

CIOX Health is dedicated to safeguarding, connecting, and delivering critical health data to enhance decision-making and promote better health outcomes. As a leader in data logistics for the healthcare sector, our solutions empower organizations to securely transfer and connect vital information. With a vast network comprising thousands of entities, including over 70,000 hospitals and clinics, and partnerships with more than 500 real-world data providers, we are at the forefront of healthcare innovation.

Joining CIOX Health means becoming part of a collaborative, remote-first team committed to driving transformative change in the healthcare landscape. We seek individuals who are intelligent, kind, and results-oriented. Our investment in our team members reflects our belief in nurturing high-potential individuals who can grow alongside the company. Our distributed workforce is empowered to create a work environment that best suits their individual needs.

As a Professional Fee Audit Specialist, you will play a crucial role in addressing consulting and educational needs related to coding quality, compliance evaluations, external payer assessments, coding education, interim coding management, and workflow operations reviews. This position allows you to provide valuable insights tailored to exceed client expectations while actively identifying and proposing solutions for any challenges that arise. Enjoy the flexibility of a fully remote role, enabling you to contribute to the future of healthcare from your chosen workspace.

Responsibilities

Key Duties:
  • Conduct Professional Fee encounter reviews of inpatient, outpatient, and clinic-based medical records, utilizing ICD-10-CM, CPT, HCPCS, and modifiers along with relevant coding references for accurate coding assignments.
  • Examine all HCPCS and CPT codes that affect RVU assignments.
  • Deliver coder education through the auditing process.
  • Prepare preliminary results for review by the facility or HIM director.
  • Address any coding recommendation disagreements with the appropriate manager.
  • Compile final reports for coding audits and participate in resolving audit findings.
  • Provide coder education via email or conference calls based on audit findings.
  • Attend coding workshops as necessary.
  • Stay updated on regulatory changes.
  • Manage and prioritize multiple cases concurrently to ensure efficient departmental workflow and resolution.
  • Exhibit versatility and exemplary performance across a wide range of coded services.
  • Engage with client facility representatives to discuss issues and trends identified during audits.
  • Develop and implement educational initiatives for physicians, nursing, and clinical staff to enhance documentation practices.
  • Demonstrate initiative and sound judgment in fulfilling job responsibilities.
  • Communicate effectively with colleagues, management, and hospital staff regarding clinical and reimbursement matters.
  • Maintain a professional, efficient, and positive demeanor.
  • Adhere to the American Academy of Professional Coders (AAPC) code of ethics.
  • Exhibit a strong customer-service orientation and demonstrate professionalism, flexibility, dependability, a desire to learn, and a commitment to excellence.
  • Audit external coding staff as required and provide reports to management as directed.
  • Handle complex work functions and decision-making with confidence.
  • Possess strong organizational, teamwork, and leadership skills.
Qualifications

Required Qualifications:
  • A minimum of 3 years of experience in coding or auditing.
  • CPC and/or CPMA credentials are required.
  • Recent experience in academic or level 1 trauma centers.
  • Experience in coding or auditing Professional Fee encounters for inpatient, outpatient, and clinic-based records across various facilities.
  • Proven track record of meeting acceptable productivity standards.
  • Maintain a 95% accuracy rate for code assignments and a 95% productivity rate.
  • Familiarity with various software applications, including EMR, Encoder, and Auditing software.

Perks:

  • 401k Savings Plan.
  • Company-provided equipment, including computer, monitor, mouse, etc.

To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof of various vaccinations. Requests for exemptions will be reviewed on a case-by-case basis.

This position requires a high-speed internet connection and a work environment free from distractions. Please note that assessments may be required as a condition of employment for this role.

Pay ranges for this job title may vary based on location, responsibilities, skills, experience, and other role requirements. The estimated pay range for this role is $35 - $40 per hour.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Pay Act Minimum Range

$40.00 per hour

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