What are the responsibilities and job description for the Coding Integrity Auditor position at ConnectiCare?
Summary of Position
- Responsible for upholding the standard for code review functions in the setting of claims review, grievance and appeal, and
- Identify inconsistencies between CCI & EH reimbursement policies and claim which directly impact claim payment (i.e.
- Perform audit of suspended and appealed claims reviewed by coding staff.
- Perform audits of outlier providers for accurate coding practices and documentation requirements.
Principal Accountabilities
- Audit internal and external business partners (processes and results) for accurate claim coding reviews for various
- Audit claim reviews and medical records to ensure accurate adjudication; review decisions from Coding Integrity team;
- Review reporting for outlier provider claims; request patient medical records to assign diagnoses, treatments, and
- Provide direct education to the business and provider offices as needed to facilitate an understanding of correct claim
- Perform audits of changes to coding introduced by new medical policies, reimbursement policies, regulatory changes,
- Participate in RPC, RPCW, Medical Policy Committee (MPC) and Medical Policy Committee Workgroup (MPCW) as
claim reimbursement.
- Identify reimbursement and coding variances from industry standards and brings to leader’s attention.
- Provide support for internal and vendor edit reviews and provider contracts.
- Perform related tasks as directed or required.
Education, Training, Licenses, Certifications
- Bachelor’s degree, preferably in a healthcare, quantitative/analytical, or business related field of study.
- AAPC CPC (AAPC Certified Professional Coder) &/or CCS (AHIMA Certified Coding Specialist)
- AAPC CPMA (AAPC Certified Professional Medical Auditor)
Relevant Work Experience, Knowledge, Skills, and Abilities
- 3 – 5 years of coding experience. (R)
- 1 year auditing experience. (R)
- Additional years of related work experience/specialized training may be considered in lieu of educational requirements. (R)
- Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) (R)
- Attention to detail; and ability to communicate or escalate issues in a timely manner. (R)
- Ability to independently prioritize and complete multiple tasks with competing priority levels and deadlines. (R)
- Ability to perform effectively in a fast-paced work environment. (R)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types and levels of audiences. (R)
Additional Information
- Requisition ID: 2301X
- Hiring Range: $52-$92
Salary : $52 - $92
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