Coding QA/Compliance Specialist

P3 Health Partners is committed to ensuring the health and safety of our team members, patients and communities we serve. As a part of this commitment, all candidates must receive their COVID-19 vaccine prior to joining the team. If you have any questions about our interview and hiring procedures, please contact PeopleServices@p3hp.org.

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. 

We are looking for a Coding QA/Compliance Specialist for Medicare Risk Adjustment (MRA). If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing national organization based in Henderson, Nevada, then consider joining our team!

Responsibilities of the Coding Compliance Auditor include but are not limited to:

• Perform detailed coder audits on a regular basis as defined by compliance requirements, determine and provide when additional education is necessary.
• Conduct internal audits of medical record documentation supporting MRA data capture, CV coding, retrospective review including claims billed to Medicare, other federal programs and commercial payors.
• Conduct pre-audit of CMS RADV requested cords and/or health plan compliance audits to ensure submitted HCC diagnosis codes are supported in the medical record.
• Evaluate the appropriateness of diagnoses coded from CV program, retrospective review, billing for all services in accordance with coding and documentation guidelines.
• Evaluate appropriate level of service billed for evaluation and management services based on the supporting documentation.
• Evaluate the appropriateness of the EHR functionality being used, completing second level reviews on high complexity disease categories.
• Conduct educational documentation and coding training for clinicians, and coders to support compliance with guidelines from AHA, AMA, CMS and health plan standards.
• Prepare formalized reports from audit results and present the results to MRA leadership.
• Respond independently to questions from physicians, practice managers, executive leaders, coders, clinical reviewers, other market staff regarding billing, coding and documentation.
• Develop educational programs for coders and/or providers based on audit findings along with general education on coding and documentation rules and regulations.
• Perform follow-up reviews after initial training of the coders and determine if additional education is necessary.
• Provide any additional training once identified by follow-up review.
• Communicate regularly with MRA leadership to ensure all necessary information is received on a timely basis.
• Communicate and problem solve with directors, managers and supervisors on specific coding issues and/or training requests.
• Work on joint projects with other teams such as clinical review, coding educators, and others from the specific markets.
• Perform any and all other assigned responsibilities.

Education and Experience:

• Successful completion of Coding Certificate program from an accredited organization (i.e. CPC, CRC, CPMA from AAPC, or CCS, CCS-P from AHIMA), with 3-5 years of professional coding experience

• Two years of public speaking, talent development and/or training experience

• Direct experience in understanding and implementing Medicare Risk Adjustment (HCC) coding compliance rules and regulations

Knowledge, Skills and Abilities:

• Demonstrate high-level expertise in understanding Medicare Advantage insurance carrier rules and regulations, and the ability to manage ongoing change, and think creatively

• Thorough knowledge of government regulations relating to medical records documentation and reimbursement including Medicare, Medicaid and other industry billing standards

• Leadership skills including: setting the example, motivating the team to be high performers, customer service-oriented, taking the initiative to achieve the outcome

• Superior skills in Microsoft Office (primarily excel and power point)

• Must possess solid analytical, problem-solving, planning, communication, documentation, and organizational skills with meticulous attention to detail

• Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences

• Ability to monitor project progress and communicate results to the MRA team, vendor partners and senior management as needed

• Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy required

• Ability to analyze, interpret and communicate recommendations to MRA team, vendor partners and senior management

• Ability to communicate clearly and effectively both orally and in writing required

Essential Functions:

• Build relationships with internal and external customers, providing superior customer service while managing expectations

• Assist in maintaining the MRA operational goals and metrics, in support of the department’s and organization’s strategy

• Collaborate with other organizational leaders to identify emerging needs and rally around solutions

• Develop and maintain working relationships with our Clinic Partners, including providers and their support staff

• Meet deadlines and turnaround times set by managers and department director

• Ability to work with multiple internal and external partners at various levels of the organization

• Strong aptitude for quickly troubleshooting and identifying the cause of questionable results within extracts and reports.

EQUAL OPPORTUNITY EMPLOYER

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

DIVERSITY & INCLUSION

At P3, we recognize and appreciate the importance of creating an environment in which all team members feel valued, included, and empowered to do their best work and bring great ideas to the table

Every P3 family member's unique experiences, perspectives, and viewpoints are valued and support our ability to deliver the best possible experience for our patients, providers, payers, partners, and each other.