Remote Profee Multispecialty Coder

Presbyterian Healthcare Services • Remote Workers New Mexico, NM

1d • $24 - $37 • Remote

About The Position

Presbyterian is hiring a skilled Remote Multispecialty Pro Fee Coder to join our team. This is a full-time, exempt opportunity for remote workers in New Mexico with varied days and hours.

Requirements

• High school diploma/GED required.
• Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS.
• A minimum of three (3) years experience in coding and/or auditing required.
• Excellent written and verbal communication skills.
• Detail and results oriented.
• Ability to work independently and make independent decisions.
• Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.
• Proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for service lines(s) assigned.
• Excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously.
• Computer skills, especially with Microsoft Word, PowerPoint, and Excel applications.
• Ability to use the internet and other resource applications for research purposes and to provide documentation that supports regulations quoted in audits.
• Strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in laymans terms.
• Possess a personal presence of a highly qualified professional that is characterized by a sense of honesty, integrity, and the ability to inspire and motivate others.

Nice To Haves

• Audit experience preferred.

Responsibilities

• Implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS.
• Compliance to all external regulatory agency coding rules and regulations.
• Performing and/or managing on-site internal audits or reviews to assess compliance/quality monitoring performed by PHS/PMG departments.
• Serving as a resource on documentation, coding, billing, and coding compliance questions.
• Working on special coding compliance related projects.
• Developing and presenting educational programs.
• Disseminating information to PHS/PMG departments.
• Developing educational tools used to maintain compliance with regulations.
• Auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers.
• Performing medical record and billing reviews of denied and appealed claims and taking appropriate action to ensure accurate payment of claims.
• Coordinating review and tracking of appealed claims including the communication process with affected payers.
• Researching and interpreting all regulatory agency regulations.
• Acting as a liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems.
• Interacting with all levels of management.
• Maintaining accurate, complete and timely documentation in either electronic or hard copy form.
• Adapting to frequently changing work priorities and schedules.
• Maintaining and disseminating up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area, including all ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes.
• Researching coding, billing and charging compliance issues, recommending and implementing corrective action plans that assure compliance with regulatory agencies where appropriate.
• Identifying risks, developing and following up on action plans, identifying lost revenue opportunities and any overpayments due to errors in coding and/or documentation, and providing compliance education.
• Assisting in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments.
• Regularly exercising independent judgment in determining the reliability of data reviewed; recommending changes in existing practices to gain or maintain compliant behavior.
• Keeping actively informed on the business climate of the healthcare industry.
• Responding to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.

Benefits

• Medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Employee Wellness rewards program designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED