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Concentra · 1 month ago

Coding and Compliance Auditor

Addison, TX

Full-time

Onsite

Mid, Senior Level

4+ years exp

Concentra is recognized as the nation’s leading occupational health care company dedicated to improving the health of America’s workforce. The Coding and Compliance Auditor will perform detailed coding and documentation audits to ensure compliance with clinical and coding guidelines, providing feedback and education to clinicians on documentation and coding practices.

Health CareHospitalMedicalPrimary and Urgent CareTherapeuticsWellness

Responsibilities

Complete compliance audits for designated clinicians/centers consistent with established audit protocols and nationally recognized guidelines

Meet the production and QA standards as set out in Concentra Coding and Compliance policies

Analyze audit findings and identify/assess potential compliance risks related to coding and billing and notify clinical leadership regarding outliers

Organize and present the audit findings to each clinician as indicated by either the audit results, denial and down coding trends, and/or as requested by medical leadership, center leadership or Central Billing Office leadership

Schedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises

Assist CBO's with reconsideration, appeals process and coding support as requested

Participate in special projects and collaborate with other departments to support coding, auditing, and compliance initiatives

Provide clinician support, education and training related to the quality of documentation, level of service, procedure and diagnosis coding consistent with established coding guidelines and standards

Collaborate with Medical Leadership in development of clinician training plans and for active support in the training process under guidance of coding leadership

Monitor Coding and State Workers’ Compensation changes to ensure that most current information is available

Ensure adherence to all State and Federal guidelines applicable to coding, billing and documentation compliance for Worker's Compensation in all served markets

Qualification

Certified Professional Coder (CPC)Certified Coding Specialist (CCS)CodingAuditing experienceEvaluationManagement GuidelinesState Workers’ Compensation regulationsCustomer service skillsWrittenTrainingAttention to DetailOral communicationTime management skillsPresentation skills

Required

High School Diploma or GED

Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)

Maintain a coding credential from AAPC or AHIMA organization

Must complete CEUs to maintain this credential bi-annually or as required by the organization

Obtain and maintain membership to the AAPC or AHIMA organization

Customarily has at least four (4) years of experience working as a certified Coder

Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility

Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions

Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism

The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies

Coding and auditing experience

Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access and similar databases

Working knowledge of routine and non-routine concepts, practices and procedures within billing and coding

Strong understanding and application of Evaluation and Management Guidelines

Excellent process and time management skills

High degree of accuracy and attention to detail

Organized and ability to analyze multiple sources of data

Proficient written, oral communication

Work independently and as part of a team

Able to multi-task

Ability to meet multiple deadlines

Expertise in scheduling and facilitating Training and presentation skills (in person and virtual)