Coding Consultant I, II, or III DOE
About The Position
Every day, Cambia’s dedicated team of Coding Consultants are living our mission to make health care easier and lives better. As a member of the Payment Integrity team, our Coding Consultant coordinates, monitors, and audits documentation and coding of inpatient and/or outpatient services in all applicable health care settings. Analyze audit results, identify patterns, trends or variations in coding and documentation practices and make recommendations for improvement. Initiate and/or recommend corrective action plan to ensure resolution of problem areas identified during auditing and monitoring activity. Support internal/external departments with coding research and insight – all in service of creating a person-focused health care experience. What if your coding expertise didn't just process claims — it actually shaped the future of person-focused health care? What if your coding knowledge was the bridge between clinical teams, internal departments, and the health care experience members deserve? Then this role may be the perfect fit.
Requirements
- Bachelor's degree in business administration or related health care field
- 3 years coding experience
- 2 years of experience participating in coding audits and quality performance measures, preparing audit reports with recommendations, and providing education and feedback to facilitate improvement in documentation and coding or equivalent combination of education and experience.
- Certification in at least 1 of the following is required at the time of hire, and throughout tenure in job: Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), RHIT (Registered Health Information Technician), or RHIA (Registered Health Information Administrator)
- Understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
- Basic knowledge of CDT and revenue codes.
- Knowledge of ICD-10, CPT, HCPCS.
- Demonstrated ability to provide effective statistical analysis and analytical problem solving.
- Strong working knowledge of the critical elements of the coding process.
- Demonstrated ability to communicate, verbally and in writing, clearly and effectively with a wide variety of individuals at all levels of the organization.
- Knowledge of adult learning principles.
- Basic computer experience and ability to learn new computer applications quickly and independently, including: Microsoft Office Suite and other software products.
- Ability to manage significant work load, and to work efficiently under pressure meeting established deadlines with minimal supervision.
- Understanding of government rules and regulations and areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation.
- Basic knowledge of insurance reimbursement methodology
Nice To Haves
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
Responsibilities
- Identify trends and patterns; collate audit results and analyze findings; identify root cause analysis; and identify system issues that may contribute to claims, coding, provider contracting and revenue cycle deficiencies.
- Prepare written audit report for noted deficiencies and make recommendations to internal/external departments and others as appropriate/requested (i.e. training, oversight, monitoring, process flows, etc).
- Assist in the development, implementation and completion of corrective action plans for noted deficiencies.
- Contribute to the development and maintenance of procedural documentation for internal controls to assist with coding training, education, policy development, and compliance materials.
- Uses knowledge of CPT, HCPCS and ICD-10 coding to perform assigned research.
- Supports other areas within the department by serving as a resource for coding questions.
Benefits
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
- Competitive base pay
- Market-leading 401(k) with a significant company match
- Bonus opportunities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
