Coding Auditor - Centrum Health

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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives - apply to join our team.
SCOPE OF ROLE
It is the primary function of the Coding Auditor is to serve as a coding expert resource for the Coding staff, providers, and support staff. They will act as the first line of coding support, ongoing training and education of coding staff to improved documentation, and best coding practices and to ensure compliance with company standards, Medicare, OIG, AMA, and health insurance payer policies.
ROLE RESPONSIBILITIES

• Monitors, and evaluates work performed by coders; reports any issues to the Coding Manager.
• Monitors and reports medical record documentation to identify potential issues. Reports unusual and complex issues. Recommends action plans and suggests processes for improvements.
• Works with Coding Manager to establish, implement, and maintain a formalized review process for coding and documentation compliance. Monitors and adheres to the audit schedule. Analyzes audit results, identifies trends, and presents audit/review findings, potential issues, and their root causes to ensure audit results are disseminated and understood. Provide education based on audit findings.
• Participates in educational activities to maintain current credentials, as well as enhance knowledge and skills. Attends department staff meetings and aids other departments as requested by managemen
• Special Projects

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Current coding certification through AAPC (CPC) or AHIMA (CCS)
• Current Coding Auditor certification (AAPC) for at least 2 years.
• Minimum of 5 years overall coding experience with a minimum of 3 years in Risk Adjustment.
• 2 to 3 years in risk adjustment with multiple models (ACA, Medicare, Medicaid, and Commercial) and mapping.
• 3 + years of healthcare revenue cycle management, billing, and collection-related work experience. General understanding of professional fee billing processes and procedures.
• Current knowledge of coding guidelines and current CPT, ICD-10, and HCPCS coding, fee schedule reimbursement methodology, and regulatory requirements for provider coding and reimbursement.
• Working knowledge of key coding concepts, such as CPT modifiers, surgical packages, medical record documentation requirements, and multiple procedure guidelines. Proficient in analyzing statical data
• Bilingual: English and Spanish
• Strong knowledge on medical terminology, medical abbreviations, pharmacology, and disease processes.
• Deep expertise in finding coding resources and answering specific coding questions.

LICENSURES AND CERTIFICATIONS

• One or more of the following accreditations: CPC, CCS, CPMA, RHIA
• Risk adjustment and auditing credentials desire: CRC, CDEO.

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Travel will be required to Medical Centers office (70%). This is not a work at home position.

We're Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
Focusing on Consumers We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
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We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.