Auditor

• Support implementation and compliance with enterprise-wide and department coding policies and procedures
• Ensure compliance with external regulatory agency coding rules and regulations
• Perform and/or manage on-site internal audits and quality reviews
• Serve as a resource for documentation, coding, billing, and coding compliance questions
• Work on special coding compliance-related projects
• Develop and present educational programs and tools
• Audit and train enterprise-wide corrective action plans for low-performing coding, audit, physician, and clinician personnel
• Review denied and appealed claims and take appropriate action to ensure accurate payment
• Coordinate review and tracking of appealed claims and communicate with affected payers
• Research and interpret regulatory agency regulations
• Liaise with Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance, and ancillary departments
• Maintain and disseminate current legal and regulatory information, including ICD-9, ICD-10, CPT-4, HCPCS, and APC updates
• Research coding, billing, and charging compliance issues and implement corrective action plans
• Identify risks, lost revenue opportunities, and overpayments due to coding or documentation errors
• Assist in creating the CDQA Annual Audit Work-plan
• Respond to daily coding and auditing inquiries and ad-hoc analysis requests
• Maintain working knowledge of PHS coding and auditing IT applications
• Gather and analyze information and recommend solutions for business issues
• Conduct coding, documentation, and compliance training classes, including ICD-10 and EPIC EMR documentation education
• Conduct focused internal audits through medical record and charge ticket review
• Analyze and communicate medical record and account audit findings to management
• Develop methods and processes to improve coding efficiency and effectiveness
• Research and investigate patient care and billing concerns
• Monitor reports and quality audits to ensure coding functions meet quality and performance standards

Explore CPMA Educator, Auditor at Presbyterian Healthcare Services. Review requirements and application details.