Description
Tri-Cities Community Health (TCCH) is looking for a Documentation and Coding Auditor who has a passion for helping others. As a community health center, located in southeastern Washington, serving Pasco, Kennewick, Richland and the surrounding communities.
TCCH offers a variety of schedules to support a work-life balance. Most of our clinics offer Monday-Friday day shifts, with no weekends or holidays, competitive salaries and benefits. While providing careers in a fast-paced work environment and opportunities for professional development.
We employ a highly diversified group of talented individuals who are dedicated to fulfilling our mission to provide the highest quality patient care with the greatest degree of professionalism and courtesy regardless of a patient’s ability to pay.
Our Mission:
We are dedicated to the communities we serve, bringing together a unified team that delivers the highest-quality health care to every person, every time.
Our Opportunity
Responsible for the review and follow up auditing of new and existing medical records in accordance with the clinic's compliance plan. Training of clinical, billing and administrative staff on provider rules, CPT and ICD-9/ICD-10 coding, focusing specifically on the accuracy of the provider coding and adequacy of the documentation. Coordinates, implements, monitors and enforces compliance initiatives for TCCH.
Essential Functions:
- Analyzes patient medical records and interprets documentation to identify all diagnoses and procedures. Assigns proper ICD-9 (10)-CM and HCPS diagnostic and operative procedure codes to charts and related records by reference to designated coding manuals and other reference material.
- Conducts audit of all provider records to ensure compliance with coding and documentation guidelines. Audits all new providers monthly until 90+% accuracy and audits all providers quarterly or as needed based on accuracy of providers’ coding.
- Provides written reports regarding accuracy and improvements needed to providers, supervisor and Director of HR.
- Assesses the adequacy of medical record documentation to ensure that it supports the principal diagnosis, principal procedure, complications, and comorbid conditions assigned codes.
- Work as a liaison between billing department, providers and other medical staff for clarification regarding diagnosis, missing documentation for nursing visits, splitting encounters for L&I.
- Actively participates with external contacts: insurance companies, Medicare and Medicaid and vendors. Develops and presents pertinent information to appropriate administrative and medical staff departments.
- Responds to questions, issues, and reports of potential issues in coordination with TCCH Management.
- Answers physicians/clinicians questions regarding coding principles. Assists finance, data processing, and other departments as needed.
- Remains current with developments in medical record technology by pursuing a program of professional growth and development, attending educational programs and meetings, reviewing pertinent literature, and so forth.
- Assists with preparation and communication for external audits.
- Focused documentation review (Behavioral Health Coding, Vision Coding, Payer Specific Coding & Guidelines, Medical Necessity, diagnosis review, E&M coding, Problem Code Reviews).
- Audit for accuracy on off-sites and provide feedback/training to biller/provider.
- Participate in planning and rolling out ICD implementation to all services lines as necessary.
- Coordinates implementation, monitoring and enforcement of compliance initiatives for employed providers, to comply with applicable laws as they pertain to billing procedures and requirements.
- Responsible for clinical documentation analysis (medical, dental, vision and behavior health), documentation completeness, coding accuracy and compliance.
- Assists with training and education related to corporate compliance to providers and staff in all departments.
- Coordinates audit and training activities with their manager. Independently assesses critiques and makes authoritative recommendations for revisions to the organization’s coding and documentation techniques and policies. Monitors compliance on an ongoing basis and ensures that approved recommendations are implemented and reported to the Risk & Compliance Department.
- Able to carry out all other duties as assigned.
Requirements
Education:
- High school diploma/GED required. Billing/Coding training desirable.
Experience:
- Two years’ experience in compliance, review and auditing in a clinic or physician practice setting preferred.
License/Certification:
- CPC, CCS-P or AHIMA certification required.
- ICD-10 certification preferred.
Knowledge/Skills/Abilities: Knowledgeable and proficient in CPT/ICD-9/ICD-10 coding, medical billing, claims processing, medical terminology, and Microsoft Office products. Familiarity with coding software preferred. Ability to interpret, comprehend and transmit complicated and detailed instructions accurately required. Must demonstrate positive working relationship with providers and peers. Strong communication skills required.
Benefits:
- Paid Time Off - Sick, Vacation, and Holidays
- Medical, Dental, and Vision
- Flexible Health Spending Account and Dependent Care Spending Account
- CME Reimbursement (if applicable)
- Retirement - 403(b) with matching contributions
- Employee Assistance Programs
- Life Insurance
Tri-Cities Community Health is an Equal Opportunity Employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, veteran status or any other protected factor under federal, state or local law.
#J-18808-Ljbffr
