Facility Inpatient/Outpatient Auditor
Are you interested in joining one of the nation's leading providers of medical coding services that is experiencing impressive year-over-year growth? Aviacode is nationally recognized as one of the top medical coding companies in KLAS and Black Book Market Research surveys. Here is your opportunity to be part of this exciting team. We are hiring now and have an immediate need for an Inpatient/Outpatient Auditor.
The Inpatient and/or Outpatient Auditor is responsible for assigned auditing projects and assisting clients in maintaining compliant auditing operations. These projects include, but are not limited to auditing, instruction/education, reimbursement theory, clinical documentation opportunities/improvements, as well as use and interpretation of data analytics.
- Develops and provides ongoing training/education to support application and adoption of ICD-10-CM/PCS coding and documentation concepts for internal and external coders.
- Auditing -IP Audits to include: ICD-10-CM/PCS, and HCPCs Level I and II codes, including specific focused audits, custom audits, and general application audits. All audit processes include responsibility for coordinating and managing timeline of deliverables to customer. These processes include initial scheduling call with client and project management department, validating information with project management department, performance of record review based on scope of work, review of all medical record documentation, accurate data entry into the audit tool, and coordination with team members to insure that deadlines are met.
- Auditing-OP Audits to include: Responsible for accurate data entry into the Audit tool, if applicable. Responsible for review of all medical record documentation in order to validate correct reporting of services provided. Responsible for validating complete physician order for all outpatient services. The components of a complete physician order include diagnosis/diagnoses; date and time order was written/entered; specification of service to be provided, valid physician authentication including date and time order was authenticated. Responsible for validating that service ordered was provided and billed with appropriate HCPCS code(s).
- Responsible for validating that all data elements transferred from the charge entry and coding systems to the UB-04 and to the payor's claims processing system. Responsible for validating appropriate payment was received by the client upon adjudication of the claim.
- Responsible for researching and reviewing all applicable Local Coverage Determinations (LCDs) for appropriate FI/MAC as well as CMS National Coverage Determinations (NCD) in order to evaluate appropriateness of reimbursement received.
- Responsible for following all modifier requirements and rules based on CPT and CMS guidelines. Responsible for providing education and feedback to clients after audit is completed. Responsible for staying current with CERT, MAC, RAC and other entities targeted subjects. Responsible for staying current with HCPCS code and Outpatient Prospective Payment changes each year
- Validating accuracy and completeness of all medical record documentation; validating that service was ordered, provided and reported with appropriate code(s); all data elements transferred from the charge entry and coding process through the billing system and the payor's claim processing system, including validation that appropriate payment was received by the client upon adjudication of the claim.
- Researching and reviewing all applicable coverage determinations/policies in order to evaluate medical necessity and resulting appropriate reimbursement; follow all reporting rules (e.g., application of modifiers, reporting POA) and correct coding rules. Coordinates and provides education content, financial impact information and other statistical reports, as well as conducting an education session and exit conference for client after audit is completed. Insures that appropriate person (e.g., compliance officer, attorney, etc.) is apprised of all potential compliance risk areas if/as they are identified. Responsible for maintaining knowledge regarding current target subjects as identified by CERT, MAC, RAC, etc., as well as Official Coding Guidelines, AHA Coding Clinics, HCPCS code updates, IPPS and OPPS updates.
- Provides, if required, continuing education to internal and external clients regarding changes to coding and reimbursement systems.
- Assumes personal responsibility for professional growth, development and continuing education in order to maintain a high level of proficiency.
- Maintains confidentiality of all types of protected health information and personally identifiable information.
- Mentors team members in areas to promote team work and elevate skill sets.
- Other duties as assigned
- Certified as RHIT, RHIA, CCS, CPC, Specialty CPC, COC, RN, CIRCC, and/or CDIS
- Direct experience with and knowledge of hospital revenue cycle, auditing, coding validation, and/or physician/practitioner E/M theory and revenue cycle.
- Understanding of DRG, POA, APCs, OPPS, Modifiers, NCCI, LCD, OCE and/or Medicare Physician Fee Schedule (MPFS)
- Experience with presentation of education and/or audit results to high level hospital representatives. Ability to communicate effectively with physicians and other clinical disciplines.
- Thorough knowledge of medical terminology, anatomy and physiology and pathophysiology.
- ICD-10 Implementation, training of others in ICD-10 and/or native I-10 experience
- Remote work experience preferred
- Advanced Microsoft office user and Power Point
- Interest in Data Analytics
- Ability to travel and be reimbursed for travel expenses upon submission of expense report and approval by client and Aviacode.
- Experience in any of the following areas a plus: UR, Case Management, CMS, OIG, or RAC
- Computer knowledge and experience with GEMS or Mapping I9 to I10 a plus
- Good communication skills both written and verbal required