Outpatient Complex Audit Specialist/Full Time/Remote
About The Position
Under the direction of the Outpatient Audit, Analytics & Technology Supervisor, in conjunction with OP Audit Analysts and Coordinators will utilize documentation and coding expertise to facilitate audits of the quality and completeness of medical record documentation for outpatient encounters, including but not limited to clinic visits, outpatient surgical procedures, telemedicine, and other ancillary services. Through concurrent, prospective and retrospective evaluation and assimilation of the medical record, the OP Audit - outpatient complex audit specialist will be responsible for utilizing knowledge of Local, State and Federal coding guidelines and regulations, NCCI Edits, ICD-10CM, CPT, Hierarchical Condition Categories (HCC), standards of compliance, and clinical knowledge to accurately abstract information from the electronic health record for compilation of an OP CDI Education database, which supports the Documentation & Coding Provider Education Program, data-driven resourcing, monthly provider performance scorecards, revenue cycle projects, KPI metric dashboards, and administrative decision making related to Revenue Cycle.
Requirements
- High school diploma or G.E.D. equivalent required.
- Minimum of two (2) years coding experience required.
- Additional specialty coding certification or 5-7 years coding experience required.
- Prior experience in a healthcare revenue cycle position required.
- Must have through knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems.
- Strong organizational and time management skills required to effectively prioritize work.
- Ability to communicate effectively with colleagues, supervisor, and manager.
- Ability to work independently. Ability to work remotely.
- Proficient in medical terminology.
- Proficient in ICD-10 CM, CPT, HCC and HCPCS coding.
- Able to recognize patterns and trends and escalate to supervisors to support root cause analysis.
- Able to assist other team members.
Nice To Haves
- Specialty coding experience preferred.
- One to two (1-2) years college or additional course work in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.
Responsibilities
- Facilitate audits of the quality and completeness of medical record documentation for outpatient encounters
- Utilize knowledge of Local, State and Federal coding guidelines and regulations, NCCI Edits, ICD-10CM, CPT, Hierarchical Condition Categories (HCC), standards of compliance, and clinical knowledge to accurately abstract information from the electronic health record for compilation of an OP CDI Education database
- Supports the Documentation & Coding Provider Education Program, data-driven resourcing, monthly provider performance scorecards, revenue cycle projects, KPI metric dashboards, and administrative decision making related to Revenue Cycle.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
