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Company

Datavant · 3 days ago

Profee Audit Specialist

United States

Full-time

Remote

Mid, Senior Level

$35/hr - $40/hr

5+ years exp

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BiopharmaClinical Trials

No H1B

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Responsibilities

Performs Professional Fee encounter reviews of medical records and abstracts using ICD-10-CM, CPT, HCPCS, and modifiers and appropriate coding references for accurate coding assignment.

Reviews all CPT and HCPCS codes impacting RVU assignment

Provides coder education via the auditing process

Prepares preliminary results for review by the facility

Reviews coding recommendation disagreements with appropriate manager

Prepare the final reports for the coding audit. Participates in settlement of audit findings.

Provides coder education via email and/or conference call using the audit spreadsheet findings and comments

Attend coding workshops as necessary

Keeps abreast of regulatory changes

Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution

Shows versatility and exemplary work including a wide range of services coded

Meets with client facility representatives to discuss issues and trends identified in audit

Develops and implements education for physician, nursing, and other clinical staff to improve documentation

Develops and implements education for coding staff to improve coding procedures

Demonstrate initiative and judgment in performance of job responsibilities

Communicates with co-workers, management, and hospital staff regarding clinical and reimbursement issues

Function in a professional, efficient and positive manner

Adhere to the American Academy of Professional Coders (AAPC)’s code of ethics

Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession

Audits external coding encounters as needed and provides reports to manager as directed

High complexity of work function and decision making

Strong organizational, teamwork, and leadership skills

Qualification

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Professional fee codingAuditing experienceCPC credentialsCPMA credentialsICD-10-CMCPTHCPCSCoding educationRegulatory changes knowledgeCustomer service focusCommitment to professionTeamwork skills