Value Based Coding Auditor

1 month ago

Miami, United States Femwell Group Health Full time

Femwell Group Health is Florida’s leading management services organization (MSO) providing cost-effective business solutions so physicians can efficiently and profitably run their practices.

From managed care support to accounting and marketing, the members of our team work with physicians every step of the way to maximize productivity and efficiency for a better bottom line. We have a unique understanding of the complexities of operating a large physician group and have the expertise required to work with any medical group all the way from the early formation stages to on-going management.


Position/Title: Value Based Coding Auditor


Department: COMPLIANCE AND QUALITY ASSURANCE


Required Time Commitment (Full Time/Part Time): Full Time, eligible for paid time off (PTO), 401K benefits, and medical benefits.


Job Description: Perform various audits such as (but not limited to) data audits for HEDIS/MRA/HRA/Capitation Documentation, Coding/Special Audit Projects, and miscellaneous projects as assigned. Applicants are expected to have an intermediate/advanced knowledge of Excel and Medical Coding background.


Essential Responsibilities/Job Functions: *NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position.

  • Help download/create/clean reports provided by the payers.
  • Help create algorithms, in order to appropriately analyze the data given by the payers, as well as analyze provider performance in value based contracts and incentive programs for HEDIS and MRA
  • Monitor and report quality review statistics
  • Participate in cross-functional teams to address key claims coding rule issues facing the organization for these value based programs.
  • Perform timely and accurate quality assurance reviews of critical work tasks
  • Evaluates change proposal from a regulatory perspective, financial perspective, and claims operational perspectives.
  • This individual will, under general direction from the Senior Director of Quality & Risk Adjustment, perform and/or coordinate audits in accordance with official coding guidelines as set forth by CMS regulations, and other applicable federal and/or state guidelines (i.e., AHIMA, ACOG, CMS); and client-specific policies.
  • Investigate and/or resolve billing, coding and medical necessity compliance inquiries, complaints, and problems as directed by the VP of Quality & Risk Adjustment


Required Skills & Qualifications:

  • Minimum 1 year experience in an auditing or compliance related position, with a minimum of 3+ years’ experience in a coding/billing environment.
  • Strongly required CPC, CRC, and/or CPMA certified with good training and presentation skills.
  • Strong working knowledge of basic anatomy and physiology and medical terminology.
  • Strong working knowledge of medical insurance terminology and/or processes.
  • Excellent critical thinking capabilities with a strong attention to detail.
  • Excellent oral and written communication skills.
  • Ability to work under pressure and meet deadlines while managing multiple high priorities.
  • Exceptional customer service skills.
  • Ability to work independently with minimal supervision.
  • Computer literacy with high competency in Microsoft Excel (Pivot tables and create trends) and Word.


Other Functions

  • Attend meetings requested as per the Senior Director of Quality & Risk Adjustment.
  • Be an active participant of practice coding education through review of chart audit findings.


How to Apply:

If you are interested in this position, please send your resume to Sr. Manager of Value Based Care, Anna Cabrera acabrera@femwell.com

Please be sure to include the following in your e-mail:

  • The title of the position you are applying for in the subject line
  • The date at which you are available to start
  • Your salary requirement
  • Your contact information

Should you be a good fit, someone will contact you regarding an interview. Please note that submitting your resume does not guarantee an interview or position placement.

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