Medical Review Coding Appeals Auditor (Outpatient)

Performant Corp • Plantation, FL

92d • $65,000 - $73,000

About The Position

The Medical Review Coding Appeals Auditor (Outpatient) is responsible for conducting Appeals reviews of new evidence presented by auditees, disputing all or part of the findings from medical review audit work completed by the medical review coding audit team members. This role communicates and supports the identification of potential training opportunities or enhancements to training and/or concept review guideline materials and tools. The auditor is responsible for performing some audit activity and consistently achieves or exceeds productivity goals and quality standards. They serve as subject matter experts, provide supplemental escalation support, and may perform special project activity as needed.

Requirements

• Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P.
• Not currently sanctioned or excluded from the Medicare program by OIG.
• 3+ years of direct experience in medical chart review for all provider/claim types for outpatient.
• 5+ years relevant auditing experience in a provider or payer environment.
• Prior experience in role with responsibility for conducting primary audit, utilization management or prior-authorization work.
• Strong knowledge of medical documentation requirements and an understanding of CMS, Medicaid and/or Commercial insurance programs.
• Demonstrated ability to perform claim payment audits with high quality and production results.
• Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10.
• Proficiency with MCS 1500/UB 04 forms.
• Strong analytical skills and ability to synthesize complex information.

Nice To Haves

• Prior experience in payer edit development and/or reimbursement policy.
• Prior experience working in remote setting preferred.

Responsibilities

• Performs limited volume of outpatient coding reviews on medical records to maintain subject matter expertise.
• Conducts Appeals reviews on medical review audit work completed by the medical review coding audit team members.
• Documents Appeals results in accordance with department quality policies and procedures.
• Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client SOW, applicable concept guidelines, policies, and regulations.
• Provides correction to narrative rationale to correspond with audit determination.
• Contributes to the continuous improvement feedback process.
• Monitors, tracks, and reports on all work conducted in accordance with Appeals process.
• May prepare reports for management that includes a variety of data and trends.
• Consults with internal resources as necessary.
• Maintains current knowledge and changes that affect our industry and clients.
• Participates in and contributes to applicable department meetings.
• Successfully completes, retains, applies, and adheres to content in required training.
• Contributes collaboratively to identifying opportunities for improvement of audit results.
• May support training material/tools and best practices development.
• Contributes to positive team environment that fosters open communication.

Benefits

• Medical, dental, vision, disability coverage options.
• Life insurance coverage.
• 401(k) savings plans.
• Paid family/parental leave.
• 11 paid holidays per year.
• Sick time and vacation time off annually.

What This Job Offers

• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees