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Lead Medical Integrity Coding Auditor

Company: Rancho Health MSO
Location: Temecula
Posted on: September 21, 2022

Job Description:

Rancho Health MSO, Inc., is seeking an experienced Medical Coder Lead / Auditor to become a part of our team. You will focus on conducting quality assurance reviews on internal professional coders and providers, including physicians and advanced practice providers. This will include ongoing audits and training of coders and providers. The Lead will ensure codes are being accurately abstracted and captured in the electronic medical records and ensure that regulatory guidelines are followed by correct usage and interpretation of the official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, Evaluation and Management Guidelines, HCC's and CMMS directives. The Medical Coding Lead plays a key role in reporting quality results and tracking educational opportunities for optimized clinical documentation. This role will provide education and subject matter expertise to coders and/or providers throughout the company and will be expected to mentor and train the company's coders.

  • Support the company's consistent coding auditing accuracy rate of 95% or better while also meeting productivity standards.

    • Associate the diagnosis codes to the appropriate procedure codes (CPT) and sequence the codes accordingly to ensure proper reimbursement.

      • Ensure the coding and claim editing work queues are kept to a standard turnaround time.

        • Reconcile held accounts by resolving the edit and dropping the account.

          • Resolve coding/claim edits from various payors.

            • Identify opportunities to reduce coding edits and improve coding accuracy.

              • QUALIFICATIONS

                EDUCATION & EXPERIENCE

                • Must have a minimum of 5 years coding experience.

                  • Must have a minimum of 2 years coding auditing experience.

                    • Must have AHIMA or AAPC coding credential.

                      • Must have strong knowledge of CMMS and third-party rules and regulations.

                        • Will have knowledge of HCC value-based care clinical documentation guidelines.

                          • EPIC and Athena experience preferred.

                            • Must maintain current coding credentials.

                              KNOWLEDGE & SKILLS

                              • Strong focus on compliance and superior work ethic.

                                • Demonstrates strong collaboration skills.

                                  • Exhibits excellent teaching and training skills.

                                    • Has strong analytic and problem-solving abilities and techniques. PI191392161

Keywords: Rancho Health MSO, Corona , Lead Medical Integrity Coding Auditor, Other , Temecula, California

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