Job Id: 59556
Senior Coding Auditor and Training Specialist
This position is responsible for developing and leading a coding center of excellence (COE) group for our client to provide coding-related guidance to individuals and groups from multiple departments. Responsibilities include serving as a subject matter expert, collecting, consolidating, and preparing information for common use, and conducting training sessions. In addition to other coding guidance duties, the role conducts audits, identifies trends and reports on findings.
Candidates must reside in Oregon/Washington or be willing to relocate.
Senior Coding Auditor and Training Specialist Responsibilities
Develop and lead a coding COE group focused on providing a source of information and support for coding-related questions through meeting facilitation, Frequently Asked Questions (FAQ) documentation, etc.
Provide training, best practices, and resources for internal coders.
Assist with healthcare provider training regarding appropriate claims coding when/if necessary.
Conduct internal claims coding reviews/audits of healthcare records and claims.
Work with organizational development team and learning collaborative to utilize best practices, standards, and usage of the Learning Management System.
Act as the subject matter expert for all coding case reviews and questions.
Develop and conduct claims coding training sessions as needed for the claims Payment Integrity team.
Review healthcare records to ensure they are complete, accurate and compliant with State/Federal regulations and company policies.
Prepare investigation/coding audit finding letters for healthcare providers and respond to any subsequent questions from them pertaining to the audit findings.
Analyze claims coding data to identify coding error trends.
Use knowledge of healthcare coding conventions to identify suspicious patterns in medical record documentation.
Identify opportunities for improvement, risks to avoid, and methods to enhance internal controls across Claims, Clinical Operations, Enrollment and Payment Integrity departments (E.g., involving claims processing procedures, training, pre-payment focused claims reviews, etc.).
Compile, publish and submit detailed reports on claims coding audit findings/trends.
Present findings and recommended solutions to management and business partners.
Develop and maintain extensive recordkeeping of audit findings.
Monitor coding information from various sources of communication from coding publishers and government agencies regarding coding practice changes in ICD-10-CM.
Work in partnership with the fraud, waste and abuse (FWA) teams.
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Senior Coding Auditor and Training Specialist Qualifications
Minimum 5 years’ coding experience.
Current coding certification from AAPC or AHIMA.
Active AAPC or AHIMA membership.
Experience conducting training sessions.
Experience in provider-facing roles.
Experience conducting utilization management, especially within the Oregon Health Plan and/or the Centers for Medicare and Medicaid Services.
Behavioral health and/or dental coding experience.
Bachelor of Science in Nursing.
Knowledge, Skills and Abilities Required
Extensive knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, Modifiers and NCDs.
Extensive knowledge of state and federal regulations/guidelines including CMS NCCI.
Thorough working knowledge of medical coding for all types (inpatient, outpatient, hospital, professional, laboratory, durable medical equipment, etc.
Strong working knowledge of Microsoft products (E.g., Teams, Word, Excel, PowerPoint, etc.).
Skills and Abilities
Ability to audit medical chart notes and identify incorrect coding.
Ability to abide by the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA).
Ability to develop training programs and resources.
Strong computer skills and ability to learn new systems and processes.
Strong planning and organizational skills.
Comfort communicating with all levels of management and employees.
Excellent written and oral communication skills.
Ability to clearly present information to groups and facilitate meetings.
Ability to analyze and organize information in a clear, concise, and meaningful way.
Strong attention to detail and high level of accuracy.
Strong problem-solving skills.
Ability to function autonomously and to effectively set priorities.
Ability to work well under pressure to meet deadlines with minimal supervision.
Ability to use good judgment and think independently to perform job responsibilities.
Ability to work effectively with diverse individuals and groups.
Ability to learn, focus, understand, and evaluate information and determine appropriate actions.
Salary: $75-90K (DOE)
VanderHouwen is an award-winning, Women-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen has been successfully placing experienced professionals throughout the Pacific Northwest and nationwide. Our recruitment teams are highly specialized in either Technology and IT, Engineering, or Accounting and Finance career markets. Our recruiters value building meaningful, professional relationships with each candidate as well as developing honed knowledge of companies' staffing needs and workplaces. Partner with us to land your next exciting career.
VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state or federal civil rights laws.
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