Coding Compliance Auditor- Hospitals- Remote

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

Develops outpatient coding education. Researches complex outpatient coding issues. Conducts risk-based Coding Compliance audits and ad hoc audits of outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Develops outpatient coding education via PowerPoint and Articulate education software.
• Researches complex outpatient coding issues related to questions, inquiries, and investigations.
• Understands, interprets and applies coding guidelines for risk-based audits and ad hoc audits. Audits outpatient diagnoses, Evaluation and Management, and procedural code assignments. Reviews accounts to validate submitted codes and abstracted data including, but not limited to ICD-10-CM codes, CPT codes, and HCPCS codes which impact reimbursement. .
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (OPPS ICD-10-CM, and CPT updates) for outpatient coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to consistently and accurately audit coding of outpatient encounters
• Ability to create clear and concise audit reports and maintain productivity standards
• Must successfully pass pre-hire coding assessment
• Knowledge of medical terminology, ICD-10-CM, Evaluation/Management, Injections &Infusions, and CPT coding guidelines and methodologies
• Knowledge of disease pathophysiology and drug utilization
• Knowledge of APC, OCE, NCCI classification and reimbursement structures
• Must be detail oriented and have the ability to work independently
• Computer knowledge of MS Office
• Must display excellent interpersonal skills
• Ability to demonstrate initiative and discipline in time management and assignment completion
• Ability to work in a virtual setting under minimal supervision

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.

EDUCATION / EXPERIENCE

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Five (5) years coding experience including but not limited to hospital outpatient encounters
• Five (5) years of experience in coding audit or quality review work including but not limited to outpatient encounters.
• Three (3) years of Coding Compliance experience or the ability to demonstrate an advanced level of Coding Compliance knowledge
• One (1) year of experience preparing and delivering education as it relates to audit findings or regulatory guidance to coders and auditors

REQUIRED CERTIFICATIONS/LICENSURE

• AHIMA and/or AAPC Coding Credential, including RHIA, RHIT, CCS-P, CPC, and/or COC. Specialty credentials such as CASCC and CIRCC may be required for specialty areas.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position for extended periods
• Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Home Office Work Environment

Compensation

• Pay: $30.60-$48.80 per hour. Compensation depends on location, qualifications, and experience.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.