Provider Consultant

HiACode•Pawleys Island, SC

5d•Remote

About The Position

Performs compliance audits based on current CMS, CPT, ICD-10 guidelines, as well as all state and federal regulations. Utilizes the CMS 95/97 or 2021 documentation guidelines for evaluation and management (E&M) reviews. Writes and presents concise recommendation worksheets with appropriate findings and references to clients during summation calls. Writes Executive Summaries and must communicate with different levels within the practice/facility. Utilizes review databases (Intelicode, MD Audit, etc).

Requirements

High School diploma with at least one AAPC credential; CPC preferred
Minimum 5 years review experience in a multispecialty clinic/facility
ICD-10-CM training
Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources
Experience using Electronic Health Record (EHR)
Independent, focused individual able to work remotely.
Sound organizational, communication and critical thinking skills

Responsibilities

Prepares for Review
Reviews Evaluation and Management codes based on CMS 95/97 or 2021 Documentation Guidelines
Reviews records assigned to ensure appropriate diagnosis reporting based on ICD-10-CM Guidelines (addition, deletion, revision, re-sequence)
Reviews records assigned to ensure appropriate CPT reporting based on CPT coding conventions.
Reviews record for documentation opportunities and compliance issues based on Federal and State guidelines and/or Payor requirements.
List out findings with recommendations from guidelines/regulations (CMS Documentation Guidelines, Coding Clinic, Federal Regulations, CMS Physician Services Guidelines, etc.) to provider client with educational feedback for corrective action.
Research State/Federal and/or Payor guidelines to support recommendations made
Uses various software applications, groupers, encoders and other coding tools to analyze and ensure appropriate codes, sequencing and edits
Runs preliminary and final reports as required
Completes client rebuttals and makes appropriate changes in database as needed
Prepares for Summation Conference using Teams
Conducts Summation Conference with Administration
Conducts Summation Conference with staff and or providers as requested
Maintains adequate communication with client throughout the review process to ensure review goals and objectives are met
Leads organized summation conference in an approachable, educational manner for client staff
Provides ongoing educational support to client staff between scheduled reviews by researching issues and responding promptly to client inquiries
Maintains strict confidentiality and adheres to HIPAA guidelines
Exhibits professional demeanor at all times
Maintains communication by responding promptly to Corporate office staff
Demonstrates flexibility, open mindedness, and versatility in adjusting to changing environments
Handles constructive feedback with a positive attitude
Receptive to suggestions for changing or improving the way work is accomplished
Commits to continually improving his/her job skills (i.e. attends educational meetings)