Audit and Coding Consultant

HonorHealth•Phoenix, AZ

9d•Hybrid

About The Position

HonorHealth is seeking an Audit and Coding Consultant to join their Coding department. This hybrid position involves auditing, developing educational materials, and educating providers and coders on coding and documentation guidelines. The role also includes researching regulations for new codes, reviewing growth opportunities, and ensuring the accuracy and completeness of coding through quality reviews. The consultant will be responsible for provider and coding training programs, ensuring compliance with federal and state regulations.

Requirements

Associates or 2 years' work related experience
3 years Revenue Cycle experience
3 years Professional Coding experience
Certified Coding Audit Professional (CCAP) - Certification Required
Certified Professional Coder (CPC) - Certification Required

Nice To Haves

Bachelors
5 years coding leadership experience or equivalent

Responsibilities

Ensure appropriate methodology to include financial controls, identification of trends and unusual patterns, reimbursement deficiencies, and to improve processes.
Confirm appropriate services are provided in accordance with examination protocol and medical billing.
Work with vendor to ensure audit processes maintain appropriate controls, providing feedback to both vendor and physicians regarding results.
Identify unusual examiner patterns based on trends identifiable to the vendor/provider or coder.
Identify deficiencies in the reimbursement process and opportunities for appropriate reimbursement.
Provide a detailed report listing the findings and any adjustments required to the invoices for all inappropriately invoiced services.
Make recommendations for improvements in processes or policies and create/execute provider education for individuals and/or group sessions.
Maintain audit results and ensure provider movement throughout the compliance audit plan.
Analyze and confirm external results and as appropriate, which with senior leadership and compliance to create action plans.
Research guidelines and regulations for proposed lines of business.
Keep revenue cycle and physicians updated on new or changing regulations.
Work with IT to ensure that codes are updated and build for new services include required data points.
Performs other duties as assigned.