Remote CPMA Educator & Auditor

Presbyterian Healthcare Services•Remote Workers New Mexico, NM

2d•$60,986 - $103,813•Remote

About The Position

The Remote CPMA Educator & Auditor supports Presbyterian Healthcare Services’ Coding and Documentation Quality Assurance team with minimal supervision. The role helps implement and maintain enterprise-wide and departmental coding policies and procedures, ensure compliance with external regulatory requirements, and conduct or manage internal audits and quality reviews. The position serves as a resource for documentation, billing, and clinical coding compliance questions and tracks internal audit results across PHS. The role provides enterprise-wide training for coding, audit, physician, and clinician personnel; supports corrective action plans for identified low performers through auditing and training; reviews medical records to verify accurate billing and identify discrepancies; and responds to review requests from external regulatory agencies and insurance companies. The employee also works on clinical coding compliance projects and shares relevant information with PHS departments. The position is remote for workers in New Mexico, with travel to PHS sites, sometimes overnight, as assignments require. Working hours may vary based on assigned projects. Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system that includes nine hospitals, a statewide health plan, and a multi-specialty medical group. The organization states that it is committed to improving the health of the communities it serves.

Requirements

Associate degree required; three additional years of clinical healthcare-related experience may substitute for the degree.
Two years of clinical healthcare-related experience.
Knowledge of medical terminology, ICD-9, CPT-4, and HCPCS.
Proficient knowledge of Medicare, Medicaid, and other third-party payer documentation, coding, and billing regulations for assigned service lines.
Computer skills, especially Microsoft Word, PowerPoint, and Excel.
Ability to travel to PHS sites, including overnight travel, as assignments require.

Nice To Haves

RN credential.
Audit experience.

Responsibilities

Liaise with Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance, and ancillary departments on coding, auditing, compliance, and training issues; interact with all levels of management.
Maintain and apply current knowledge of standards of care in clinical documentation.
Maintain accurate, complete, and timely documentation in electronic or hard-copy form.
Maintain and disseminate current legal and regulatory information relevant to the business area, including ICD-9, CPT-4, HCPCS, and APC updates and changes.
Research coding, billing, and charging compliance issues; recommend and implement corrective action plans; identify risks, revenue opportunities, and overpayments; and provide compliance education.
Assist in creating the CDQA Annual Audit Work-plan using regulatory guidance, audit agency focus areas, and internal and external risk assessments.
Use independent judgment to assess the reliability of reviewed data and recommend changes to promote compliant behavior; stay informed about the healthcare industry business climate.
Respond to daily inquiries and requests concerning coding and auditing issues, problems, and ad hoc analysis for PHS management.
Maintain current working knowledge of PHS coding and auditing IT applications.
Gather and analyze information and recommend solutions to business issues for a specific business group.
Conduct coding, documentation, and compliance training for PHS personnel, including preparing materials, conducting educational audits, answering situational questions, and providing EPIC EMR clinical documentation education to providers and clinical staff.
Assist with defense audits conducted by external audit companies representing third-party payers.
Conduct focused internal medical-record audits as part of the Enterprise-Wide Coding audit team to verify coding, billing, and charging.
Analyze and summarize medical-record and account audit data and communicate findings to management.
Research and investigate internal and external customer concerns regarding patient care or billing.
Monitor system-generated reports and quality audits to ensure clinical coding functions meet established quality and performance standards.
Travel to PHS sites, including overnight travel, as required by assignments.