Job Description

Description:

Certified Medical Auditor

This role will be responsible for conducting reviews to ensure coding accuracy and adherence to current policies and procedures. This individual would report to the Revenue Cycle Manager. There will be a strong focus on accuracy and compliance.

We are looking for a detailed oriented and high organized colleague. This individual must be able to manage multiple priorities and have flexibility at our fast-growing company. We want someone who will thrive in a fast-paced environment with a willingness to learn and grow. We also want someone who will be an excellent team player and deliver great service to colleagues. Our providers and other staff are based all over the United States, so we are looking for someone who has the flexibility to communicate effectively \xe2\x80\x93 verbally and in writing \xe2\x80\x93 with colleagues around the country.

Key Responsibilities:

\xc2\xb7 Analyze coder\'s selection of diagnosis (ICD-10) and procedure (CPT I and II, HCPCS) codes to ensure accuracy and integrity.

\xc2\xb7 Ensure compliance with established coding guidelines, third party reimbursement policies, regulations, and accreditation guidelines.

\xc2\xb7 Provide a variety of complex and technical assignments relating to medical auditing.

\xc2\xb7 To provide education and be a resource to providers and staff for documentation and coding guidelines.

\xc2\xb7 To review monthly audit reports and ensure appropriate codes were capture.

\xc2\xb7 To provide oversight of work completed by external coders.

\xc2\xb7 To complete requested audits from affiliated insurance companies.

\xc2\xb7 To defend against payer audits and health plan denials.

\xc2\xb7 Perform all other auditing duties as assigned by management. Requirements:

Minimum Requirements:

\xc2\xb7 Minimum 2 years of auditing experience required/ Preferred areas of auditing: Primary care and/or Behavioral Health

\xc2\xb7 Education: Associate\'s degree required/ Bachelors\' degree preferred

\xc2\xb7 Current Certification: Certification in Professional Medical Auditor (CPMA) required

\xc2\xb7 Experience with risk adjustment audits preferred

\xc2\xb7 Must be proficient in Microsoft Office and Excel

\xc2\xb7 Work several days per week out of our headquarters in Hauppauge, NY

\xc2\xb7 Detail oriented in approach to objectives and associated tasks

Knowledge, Skills & Abilities:

\xc2\xb7 Ability to work in a multi-state practice which deals heavily with telemedicine and home-based care.

\xc2\xb7 Understanding of how licensures which including, physicians, nurse practitioners and behavioral health specialists impact coding.

\xc2\xb7 Self-starter, with high energy but also flexibility to shift directions quickly as the business requires it.

\xc2\xb7 Strong analytical and problem-solving skills

\xc2\xb7 Can effectively multitask across many different tasks to ensure high-priority tasks are completed on-time.

\xc2\xb7 Ability to work independently and in a highly virtual environment, with colleagues all over the country.

\xc2\xb7 Strong interpersonal skills to build relationships at multiple levels inside the company and with a wide array of external auditors, who review documentation and provide feedback.

\xc2\xb7 Open and accepting of suggestions, feedback, and new ideas.

\xc2\xb7 Excellent written and oral communication skills.

\xc2\xb7 Strong work ethic and a willingness to adhere to a set schedule.

PM22

PI211905627

Upward Health of Rhode Island PC