7 hours
2018-08-162018-09-15

Medical Coding Auditor - Outpatient

Performant Financial
Sunrise, FL
  • Job Code
    2018-50-6-022
Performant Financial Corporation

Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Medical Coding Auditor - Outpatient
Job Code:2018-50-6-022
Location:Sunrise, FL
Status:Regular Full Time
  
Responsibilities:
As a member of our medical audit team, the Medical Coding Auditor will have an opportunity to make a direct contribution to the company’s bottom line in our rapidly growing healthcare business. You will leverage your coding knowledge, and medical claims experience to identify client records with billing coding issues as well as investigative and auditing opportunities.
You will help identify and refine new issues for Performant to present to our clients for audit strategy, proof of concept development, and assist in developing training material or assist in training for new issues. You must possess a unique blend of medical coding experience, business aptitude and understanding of payables/receivables, commitment to excellence, critical eye for quality and accuracy, team spirit and the self-drive to meet and exceed productivity goals. 

You must enjoy spending time solving puzzles, researching, and giving attention to detail. Your depth in knowledge of medical billing standards and systems, and adaptability applying those skills will allow you to have an immediate impact to the team. Candidates who will thrive in this collaborative environment enjoy variety in their work and are willing to learn new systems and client requirements, anytime and anywhere. 

If you are ready to use your strengths in medical coding, keen eye for identifying issues, and passion for excellence in a new way, this is the job for you!  Performant Financial Corporation is a provider of technology workflow management solutions for various government, healthcare and financial services markets. We focus on audit and recovery services through our proprietary technology platform, combined with robust data analytics and experience gathered through decades of proven processes. 

Our base technology, workflow management processes and data management are flexible and extensible, as proven by our ability to service complex and competitive markets.  Performant is committed to:
•Accurate auditing of payment streams
•Efficient recovery of past due receivables
•Intelligent management of financial assets
We provide services in highly regulated arenas in the public and private sector and we are committed to work in compliance with the laws and regulations that govern the industries we serve.

What you will do:
•Objectively and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity and quality expectations.
•Conduct review of flagged claims and Fraud Waster & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. 
•Timely review and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding. 
•Appropriately refer reviews for clinical validation,  and communicate with and provide guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements. 
•Enter and update all contract and/or review findings a supporting documentation into the audit processing system.
•Write logic/parameters for system edits to detect incorrect coding over payments, aberrant and abusive coding patterns.
•Proof of concept development and data analysis of reports for potential edit development.
•Monitor CMS and major payer coding and reimbursement policies.
•Assist in identifying new issues/investigative strategies for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation.
•Maintain a current knowledge of all Medicare and Commercial regulations, policies and procedures, as well as requirements defined in assigned client(s) Statement(s) of Work (SOW).
•Maintain certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certification(s), as well as HIPPA and other compliance training provided by Performant and client(s).
•Develop and maintain professional working relationships within the department and cross-functionally.
•Notify management of:
* all correspondence indicating displeasure with the Remittance Advice (RA), in the over payment identification, or in the recovery methods utilized,
* legal action, or 
* government intervention
•Assist in developing material for training and facilitate or assist in audit training sessions.
•Assist in educating Performant team members on coding, policies, regulations, appeal strategies, etc. as needed.
•Attend conference calls and meetings as requested.
•Demonstrate Performant’s company core values as a member of the team in performing one’s role:
*People – respect for others, diversity and professionalism in communications and conduct
*Innovation – adaptability, and flexibility in applying skills in our dynamic business environment. Creativity and open minded in solving issues in our teams, in development and delivery of our products, and for our clients.
*Excellence – commitment to compliance, quality and achievement of business goals and results for our clients and for our business.
•Perform miscellaneous duties as assigned required to meet business needs in a highly professional manner

Physical Requirements
Professional business setting, sits at a desk using keyboard, mouse and monitor to perform work. Headsets provided upon request. Works assigned schedule based upon business needs (full-time 8 hours per day/ 40 hours per week, and work extended hours/overtime as required to meet business needs) and requires:
•Able to work in face paced professional business environment 
•Able to sit at desk, working on computer and phones 
•Sit/stand/walk/reach/bend/stoop 
•Lift/carry/push/pull under and over 10lbs occasionally
•Keying frequency, handling, reaching, fine manipulation
•Repetitive use of right/left arms and hands

Required Skills and Knowledge:

•Possess knowledge of CMS rules and regulations
•Proficient in the use of MCS 1500/UB 04 forms
•Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10, MS-DRG coding
•Working knowledge of encoder
•Proven ability to review, analyze, and research coding issues
•Reimbursement policy and/or claims software analyst experience
•Familiarity with interpreting electronic medical records (EHR)
•Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing
•Courteous, professional, and respectful attitude
•Adaptability of skills to handle any non-standard situations that may arise or apply skills in new ways as may be required to meet business needs
•Ability to multi-task effectively and work independently in a remote setting 
(*Must have acceptable home internet connection and meet requirements of Performant Teleworking Policies for remote work eligibility) 
•Attention to detail
•Excellent written and verbal communication skills
•Typing skills, comfortable navigating and using desktop technology, as well as working knowledge of MS Office applications (Outlook, Word, Excel).
 
Education and Experience:

•Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
•3+ years of direct experience in coding/auditing outpatient services, and medical chart review for all provider/claim types for outpatient. Coding for emergency care highly desired.  
•Some inpatient coding/auditing experience for hospital, physician’s office or clinical setting for inpatient services preferred. 
•Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
•Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.
  

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Medical Coding Auditor - Outpatient

Performant Financial
Sunrise, FL

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