Sr. Coding Auditor

Overview

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Senior Coding Auditor in Anaheim, CA.

Responsible for the oversight of all Revenue Cycle Management coding, audit and billing compliance functions for PPOBSC. Manages day to day operations for Charge Capture, Charge Audit, Coding Audit, Charge Description Master (CDM), researches activities and processes. Proactively implements changes to CDM to ensure compliance with Federal/State guidelines, and that the CDM accurately reflects all line items correctly for billing to third-party payors and patients. Ensures adherence to established policies, government regulations and payor requirements.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

• A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability.
• Benefits coverage starts after one full month of employment!
• Generous vacation, sick, and holiday benefits!
• Generous 401(k) matching contributions and more!
• To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Qualifications

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.

Licensure and/or Certification Requirements:

• Active certification as a Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA) or active certification as a Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC) is required.

Minimum Education:

• Bachelor's Degree in healthcare or related field or equivalent relevant experience preferred.

Minimum Work Experience:

• A minimum of 8 years of relevant experience in a healthcare setting working with Revenue Cycle, professional Charge Description Master and Charge-Capture.
• A minimum of 2 years experience of Family Planning coding (Family Pact).

Other Requirements:

• Ability to work independently, and adhere to productivity standards and timely tasks.
• Ability to master basic math skills and think logically in following requests.
• Ability to utilize electronic billing service system.
• Ability to converse in a calm and friendly manner, and communicate professionally by phone, email, written correspondence and in face-to-face interactions.

Responsibilities

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

• Drives the implementation of programs, policies, initiatives, and tools for Charge Capture & Correct Coding, including but not limited to institutional system-wide charge capture processes to ensure efficiency and effectiveness including the improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities; Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue.
• Collaborates with Physician and Department Leadership to review new technologies and establish related charge capture and coding protocols.
• Directs and facilitates the development of corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. This includes evaluation and identification of root causes resulting in charge capture deficiencies or lack of revenue recognition.
• Develops and executes Charge Audit Approach identifying department(s) for review including chart documentation on a regular basis to verify the clinical documentation supports the charges billed, prepare a summary report of findings, and share with department leadership.
• Oversees all audit functions, including CDM Annual Audit, Coding Audit and Charge Capture Audit, Defense audits and Concurrent audits.
• Responsible for routine and complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudication requirements for claims processing, payment and procedural accuracy.
• Identifies, proactively through auditing and internal reporting, negative and positive trends and initiates recommendations for change. Presents audit findings to all stakeholders.
• Reviews medical documentation from physicians and other healthcare providers to assign modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards.
• Directs the design/redesign of CDM processes and systems to improve service and data integrity.
• Maintains oversight of Charge Master Development, working closely with Revenue Generating Clinical Departments to ensure that coding, revenue codes, description nomenclature patient billable vs. non-billable, catalog development and updates (add/delete/change) for all CDM items are appropriate, verified through monthly feedback from Executive Leadership.
• Monitors and validate charge capture utilizing CPT, HCPCs and ICD10 codes.
• Ensures annual department CPT/HCPCS coding and CDM maintenance updates coincide with the CMS & AMA annual updates.
• Reviews existing processes to ensure proper controls are in place for the maintenance and reconciliation of CDM updates utilizing CDM Master.
• Ensures annual CDM Pricing is updated and implemented.
• Provides onsite support and training to staff on all coding related issues.

Non-Essential Functions:

• Other duties as assigned.

Disclosures

All employees are required to be fully vaccinated and received a booster for COVID-19 unless a reasonable accommodation is approved for a medical/disability or religious exemption.

Planned Parenthood/Orange and San Bernardino Counties is an equal opportunity employer. Applicants will receive consideration for employment without regard to race, color, ancestry, national origin, religion, creed, equal pay, age, disability, sex, gender, sexual orientation, gender identity, gender expression, medical condition, genetic information, marital status, military, veteran status or any other federal or state protected class. We are committed to building and maintaining an inclusive workplace that values diversity, equity, and inclusion.

Minimum Salary Range

USD $73,700.00/Yr.

Maximum Salary Range

USD $117,900.00/Yr.