Atlanta, Georgia

We are seeking a talented individual for a Coding Auditor who is responsible for auditing inpatient and /or outpatient medical records as part of our payment accuracy or fraud, waste and abuse products. These reviews determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems.

Responsibilities:

  • Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding and/or CPT and HCPC coding expertise, as well as industry knowledge to substantiate conclusions. Utilizes HMS proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
  • Assists in the development and testing of new audit concepts or tools
  • Contributes new ideas for improving existing audit processes to optimize efficiency and quality.
  • Consistently achieves productivity and quality performance standards established by management
  • Assists with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
  • Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification
  • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of coding policies, procedures, and guidelines.
  • Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs

Requirements:

  • Education (required)
    • High School Diploma required; Associates or higher degree preferred
  • Certification (one of the following are required)
    • RHIA, RHIT, CCS, CPC, COC or CASCC
  • Experience
    • 3+ years' medical record coding experience preferably in a hospital setting
    • 1+ year medical record auditing / validation experience required
    • Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
    • Demonstrated ability to write clear, accurate, concise rationales in support of findings.
    • Ability to multi-task in a fast paced working environment.
    • Ability to work independently in a production environment
    • Ability to build relationships both internally and externally.
    • Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Word, PowerPoint, Internet browsers, etc.
    • Demonstrated proficiency in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.
    • Demonstrated knowledge of medical codes, coding conventions and rules.
    • Demonstrated experience with coding systems.
    • Working knowledge of HIPAA Privacy and Security Rules.

Work Environment:

  • This is an at home-based position and you must have a work location within the continental US
  • Interviewing & training will be done remotely.
  • This position requires that you provide a high speed internet connection and a work environment free from distractions
  • This role is aligned to certain productivity and quality requirements

#LI-JB1

#LI-Remote

Atlanta, Georgia

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.

We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support retail and life/legal industries with data management and recovery audit services.

Cotiviti applies deep data science and market expertise to help healthcare organizations in three critical areas:

·        Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are paid appropriately

·        Risk Adjustment: ensuring that health plans accurately capture and report how sick their members are so that plans are appropriately reimbursed for the healthcare services their members receive

·        Quality and Performance: evaluating healthcare cost, quality, and utilization at individual, provider, and population levels to identify the best opportunities for financial and clinical performance improvement

Similar jobs