Lead Medical Integrity Coding Auditor
Company: Rancho Health MSO
Location: Temecula
Posted on: September 21, 2022
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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.
KEY TASKS & RESPONSIBILITIES
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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