Facility Inpatient 2nd Level Auditor

Overview

Facility Inpatient Second Level Auditor 

Are you interested in joining one of the nation's leading providers of medical coding services that is experiencing impressive year-over-year growth?  Aviacode is nationally recognized as one of the top medical coding companies in KLAS and Black Book Market Research surveys.  Here is your opportunity to be part of this exciting team.  We are hiring now and have an immediate need for an Inpatient second level Auditor.

The Inpatient Second Level Auditor is responsible for assigned auditing Inpatient records which have passed through the internal QA process (audit the auditor), focused auditing requested by the client, and developing education materials for the internal coding and quality teams . These projects include, but are not limited to auditing, instruction/education, reimbursement theory, clinical documentation opportunities/improvements, as well as use and interpretation of data analytics. 

Responsibilities

• Auditing –IP Audits to include: ICD-10-CM/PCS, and HCPCs Level I and II codes, including specific focused audits, custom audits, and general application audits. All audit processes include responsibility for coordinating and managing timeline of deliverables to customer.  These processes include initial scheduling call with client and project management department, validating information with project management department, performance of record review based on scope of work, review of all medical record documentation, accurate data entry into the audit tool, and coordination with team members to insure that deadlines are met. 
• Responsible for validating that all data elements transferred from the charge entry and coding systems to the UB-04 and to the payor’s claims processing system.  Responsible for validating appropriate payment was received by the client upon adjudication of the claim.
• Responsible for providing education and feedback to clients after audit is completed.  Responsible for staying current with CERT, MAC, RAC and other entities targeted subjects.  
• Validating accuracy and completeness of all medical record documentation; validating that service was ordered, provided and reported with appropriate code(s); all data elements transferred from the charge entry and coding process through the billing system and the payor’s claim processing system, including validation that appropriate payment was received by the client upon adjudication of the claim.
• Researching and reviewing all applicable coverage determinations/policies in order to evaluate medical necessity and resulting appropriate reimbursement; follow all reporting rules (e.g., MS-DRG/APR-DRG, sequencing guidelines, reporting POA) and correct coding rules. Coordinates and provides education content, financial impact information and other statistical reports, as well as conducting an education session and exit conference for client after audit is completed.  Insures that appropriate person (e.g., compliance officer, attorney, etc.) is apprised of all potential compliance risk areas if/as they are identified.  Responsible for maintaining knowledge regarding current target subjects as identified by CERT, MAC, RAC, etc., as well as Official Coding Guidelines, AHA Coding Clinics, HCPCS code updates, IPPS and OPPS updates.
• Provides, if required, continuing education to internal and external clients regarding changes to coding and reimbursement systems.
• Develops and provides ongoing training/education to support application and adoption of ICD-10-CM/PCS coding and documentation concepts for external coders
• Assumes personal responsibility for professional growth, development and continuing education in order to maintain a high level of proficiency.
• Maintains confidentiality of all types of protected health information and personally identifiable information.
• Mentors team members in areas to promote team work and elevate skill sets.
• Other duties as assigned

Qualifications

• Certified as RHIT, RHIA, CCS, CDIS, CDIP
• Direct experience with and knowledge of hospital revenue cycle, auditing, and/or coding validation.
• Understanding of DRG, POA, NCCI, LCD, and MCE
• Experience with presentation of education and/or audit results to high level hospital representatives. Ability to communicate effectively with physicians and other clinical disciplines.
• Flexibility in schedule to be able to hop on during morings/afternoons to present coding education when needed.
• Thorough knowledge of medical terminology, anatomy and physiology and pathophysiology.
• ICD-10- CM and PCS expertise is required
• Remote work experience preferred
• Advanced Microsoft office user (Power Point, Excel, Word)
• Interest in Data Analytics
• Experience in any of the following areas a plus: UR, Case Management, CMS, OIG, or RAC
• Good communication skills both written and verbal required