Auditing & Education Consultant - Profee

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

Serves in a consulting role by evaluating the work of client’s coders in their assignment of ICD-10, CPT and/or HCPCS codes to hospital inpatient, outpatient and/or physician practice encounters.  Performs concurrent or retrospective reviews to inventory code assignments and report the data to the client.  Develops and delivers educational content to clients related to audit findings.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

The Outpatient and Profee Audit and Education Specialist (“Auditor”) serves in an auditing role by evaluating the work of client’s coders and/or providers in their assignment of ICD-10, CPT and/or HCPCS codes to outpatient and/or physician practice encounters.  Performs concurrent and/or retrospective reviews to validate code assignment accuracy and compliance and adherence to federal, state, and payer guidelines.  Auditor will identify documentation and coding trends, and report findings to clients. Develops and delivers educational content to clients, including coders and providers, based on audit results and identified opportunities for improvement.

Job Description Essential Functions:

• Perform complex, concurrent and/or retrospective analysis of medical record documentation to validate coded data as recognized by the AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, and CPT Assistant.  

• Evaluate medical record documentation for accuracy, completeness and compliance with official coding guidelines, payer policies and regulatory requirement.

• Identify trends, root causes, education needs and compliance risks.

• Prepare summary reports of findings, providing specific references supporting findings contained within the audit report provided.

• Provides second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.

• Research, analyze, and respond to inquiries regarding compliance, coding, and denials.

• In all situations, protect the privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines and compliance practices, standards, and procedures.

• Functions as a member of the Consulting Services Team which develop and provide coding education to clients.

• Conduct audits assigned meeting the productivity standards as set by record type for each audit. The threshold for billable productive hours, when client work is available, is expected to be at or above 80%.

• Prepare deliverables for the client as required for the audit scope while meeting timelines.
  Conduct independent QA of their assigned audit results prior to final submission for QA review and approval. The minimum accuracy expectation is 95%.

• Report work time and work products in a timely and accurate manner.
  Communicate with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.

• Interact with clients in a professional manner exhibiting excellent relationships, work performance and communication skills to support the company and its business interests.

• Provide schedule of planned work activities, events and sites, and any changes to same, to Management and appropriate staff.

• Maintenance of professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.

• Other duties and responsibilities, as assigned.

 

Required Knowledge, Skills & Abilities: 

• One or more active credentials from AHIMA and/or AAPC: CCS, CCS-P, CPC, COC, CRC, CPMA, RHIA or RHIT). CPC of CPMA required for Professional Fee.

• Minimum 5 (five) years of outpatient and profee coding and/or auditing experience in acute care or clinic setting.  Specialty coding knowledge is preferred.

• Strong working knowledge of ICD-10-CM, CPT, HCPCS and applicable NCCI edits.

• Proficiency with multiple electronic health records (e.g., EPIC, Powerchart, Meditech etc.)

• Strong analytical skills and attention to detail.

• Strong written and verbal communication skills suitable for executive-level and operational audiences.

• Ability to manage multiple client engagements independently while meeting quality and productivity expectations.

• High attention to detail with a commitment to accuracy and ethical practice.

• Collaborative, consulting-oriented mindset with the ability to work effectively in a remote environment.

• Proficient computer skills, specifically Microsoft Office products.

Knowledge, Skills & Abilities:  Recognized credential from AHIMA or AAPC. Experience with telecommuting and electronic medical record systems required. Strong analytical skills. Proficient computer skills, specifically Microsoft Office products. Strong team player. Ability to work with multiple and diverse clients and projects. Ability to work with minimal supervision. Ability to maintain and access multiple files. Assure that work product is completed with high levels of accuracy and attention to detail. 5+ years’ experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document, or other relevant experience.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.