In-House Certified Medical Coding Auditor (CCS, CPC, RHIA or RHIT)
SUMMARY Perform regular encounter audits which ensure documentation meets requirements for diagnosis and E&M assignment, based on Official ICD-10-CM Documentation Guidelines and regulatory requirements. RESPONSIBILITIES Regular Encounter audits. Encounter Audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.Enters encounter audit results into regional audit database to support quality assurance process, regional analysis and regional training activities.Prepares and/or performs auditing analysis and/or special projects as assigned.Partners with Trainer(s) in the development of future training that will address documentation risk areas identified through audits.Conducts both Medicare, E/M, and Procedure audits on an as-needed basis.Assists in the identification of operational processes that hinder encounter data capture.Partners with Data Quality Trainer and other analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis.Assists in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.Through the use of Kaiser systems, specifically Kaiser Permanente Health Connect, researches plans for data gathering and analysis; participates significantly in interpreting analyses and developing action plans accordingly.Other Duties as Assigned QUALIFICATIONSBachelor's degree in business administration, health care, public health, finance, business medical records technology preferred.High School Diploma or General Education Development (GED) required. License, Certification, Registration.Certification in one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC).Minimum three (3) years of experience coding based on Coding Clinical Guidelines for inpatient and outpatient. Project management experience including design and implementation of audit plans.Minimum three (3) years experience conducting Medical Record audits.Ability to interpret and apply Federal and State regulations, coding and billing requirements.Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data.Strong interpersonal and excellent written, verbal and presentation skills.Demonstrated ability to work within a team environment.Willingness to be flexible depending upon department and/or physician schedule needs.Demonstrated ability to review analytical data and audit findings to identify documentation trends and other risk areas.Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.Must be able to pass proficiency exam. Company Description: SETTING STANDARDS FROM THE START In 1948, seven physicians got together to create a new kind of medical group, one that focused on collaboration, put the patient at its core and provided a truly integrated health care delivery system. The result was a practice and approach that grew to become a gold standard in healthcare. More than 30 years later and over 1,200 physicians strong, MAPMG and its integrated health care delivery model continue to forge new territory in medicine. As the quality leader in our industry, we help over 600,000 members throughout DC, MD, and VA live healthier, happier lives. And we do the same for our physicians. BALANCED LIVING IN PRACTICE As part of our team, you enjoy comprehensive administrative support, cross-specialty collaboration, easy access to resources and more. You also enjoy a balanced schedule, so you can make the most of your time here and at home. Most importantly, you will have the professional autonomy you need to do what you do best: provide truly exceptional care for your patients. OUR FACILITIES, PROGRAMS & AFFILIATIONS MAPMG boasts 30 medical office buildings throughout DC/Suburban Maryland, Baltimore, and Northern Virginia, and affiliations with several top hospitals in the region including Greater Baltimore Medical Center and Holy Cross Hospital.