Remote Hybrid Pro Fee Auditor/Educator

Responsibilities

• Supports the implementation and compliance to enterprise-wide and department coding policies and procedures for PHS.
• Ensures compliance to all external regulatory agency coding rules and regulations.
• Demonstrates proficiency in performing and managing on-site internal audits or reviews to assess compliance/quality monitoring.
• Serves as a resource on documentation, coding, billing, and coding compliance questions.
• Develops and presents educational programs to maintain compliance with regulations.
• Supports the development and tracking of corrective action plans for coding, audit, physician, and clinician personnel.
• Reviews denied and appealed claims and ensures accurate payment of claims.
• Coordinates the review and tracking of appealed claims and communicates with affected payers.
• Researches and interprets regulatory agency regulations.
• Liaises with various departments to address coding, auditing, compliance, and training issues.
• Maintains accurate, complete, and timely documentation in electronic or hard copy form.
• Maintains and disseminates up-to-date technical knowledge of legal and regulatory information.
• Identifies risks, develops action plans, and educates on compliance issues.
• Participates in creating the CDQA Annual Audit Work-plan.
• Exercises independent judgment in determining the reliability of data reviewed.
• Communicates complex regulatory information clearly and concisely to management.

Qualifications

• High school diploma/GED required.
• At least one of the following licenses/certifications: RHIT, RHIA, CPC, CCS.
• Minimum of three (3) years experience in coding and/or auditing.
• Audit experience preferred.
• Excellent written and verbal communication skills.
• Detail and results-oriented.
• Ability to work independently and make independent decisions.
• Proficient knowledge of Medicare, Medicaid, and other third-party payer documentation, coding, and billing regulations.
• Strong organizational and planning skills.
• Computer skills, especially with Microsoft Word, PowerPoint, and Excel applications.
• Ability to use the internet and other resource applications for research.
• Personal presence of a highly qualified professional with honesty, integrity, and the ability to inspire and motivate others.

Benefits

Presbyterian offers a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits. The Employee Wellness rewards program also provides engaging opportunities to enhance health and activate well-being through wellness activities like wellness challenges, webinars, preventive screenings, and more.