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Endeavor Health · 3 weeks ago

Senior Coding Quality Auditor (Remote, must live in IL, IN or WI)

United States

Full-time

Remote

Senior Level

$26.61/hr - $39.92/hr

5+ years exp

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care. The Senior Coding Quality Auditor will conduct retrospective audits for compliance with internal policies and CMS regulations, educate staff on documentation deficiencies, and manage auditing timelines to ensure operational efficiency and financial accuracy.

CommunitiesHealth CareMedicalTherapeutics

Responsibilities

Conducts Retrospective Audits to ensure compliance with internal policies and procedures and existing CMS regulations; identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy is achieved

Effectively communicates the audit process and results to the appropriate departments and management

Educates leaders and staff when deficiencies in documentation and code selected are identified

Develops timelines for auditing and manages auditing according to schedule

Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing is being performed in an accurate and timely manner and is supported by documentation

For all assigned records assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. Remains current on ICD-10 codes, CMS documentation requirements, and State and Federal regulations

Coordinates with Manager and Corporate Compliance Department on any compliance investigations that involve physician groups

Participates in compliance investigations, as needed

Attends Internal and External education programs/conferences in order to support continuous improvement, career growth and development. Encourages professional membership in the American Academy of Professional Coders (AAPC) or American Health Information Management (AHIMA)

Qualification

CPC certificationCCS-P certificationCodingAuditing experienceICD-10 knowledgeMicrosoft Office SuiteAnalytical skillsTeam development skillsProblem solving skillsInterpersonal skillsVerbal communicationWritten communicationOrganizational skills