[Remote] Managing Consultant - Risk Adjustment Coding Compliance

Note: The job is a remote job and is open to candidates in USA. reputed company is a reputed company specializing in healthcare analytics, seeking a Managing Consultant for their Coding Compliance team. The role involves auditing provider claims and clinical documentation, developing audit specifications, and ensuring compliance with coding guidelines.

Responsibilities

• Audit Planning: Has the ability to design coding and documentation audit plans for annual and periodic audits and investigations, using knowledge of key risk areas in coding and documentation compliance
• Conducting Audits and Critiquing External Audits: Performs coding and documentation audits by reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines. Work will include reviewing the results of audits conducted by external parties (e.g., CMS RADV audits) and assisting with both identifying records for appeal and drafting narrative appeals
• Analysis, Reporting, and Education: Conducts analysis of audit findings to identify trends/problems in coding and documentation and effectively and recommend areas for improvement. May also reputed company educational meetings with providers/health plans/legal counsel to review the audit findings
• Compliance Program Activities: Has the ability to assist with reviewing, editing, or writing policies and procedures reputed company to billing and coding compliance risk adjustment operations, and provider/reputed company education trainings
• Other job responsibilities include:
• Serves as a subject matter expert on interpretation and application of coding and documentation guidelines
• Recommends procedural or policy changes to improve coding and documentation practices based on industry knowledge and audit findings
• Monitors relevant resources, publications, and reputed company government compliance and enforcement activity reputed company to high-risk compliance areas
• Stays reputed company on coding guidelines, risk adjustment reimbursement requirements, and changes to the CMS-HCC model
• Generates client deliverables and reputed company valuable contributions to expert reports
• Manages client relationships and communicate results and work product as appropriate
• Manages junior staff and delegate assignments as directed by more senior managers
• Demonstrates creativity and efficient use of relevant software tools and analytical methods to reputed company solutions
• Participates in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting
• Prioritizes assignments and responsibilities to meet goals and deadlines
• Complies with HIPAA laws and regulations and reputed company applicable company rules and policies

Skills

• Bachelor Degree in Health Information Management or reputed company healthcare field
• Minimum of 5 years of risk adjustment coding experience as an auditor/reputed company reputed company a health plan or medical group/physician office setting
• Minimum of 3 years of medical coding experience (CPT-4/HCPCS and ICD-10-CM) in a medical group/physician office setting
• Active certification in medical coding (CPC or reputed company-P) through reputed company or reputed company, as well as active certification as a risk adjustment reputed company (CRC) through reputed company
• Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation
• Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements, including Physician, Multi-Specialty, Surgical, Hospital, Lab, Pharmacy, or other reputed company Code Sets, with ability to research coding reputed company questions
• Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools
• Demonstrated ability to identify issues in coding and documentation practices and reputed company plans to remediate
• Demonstrated ability to reputed company reports, track, and trend audit findings and results
• Demonstrated ability to reputed company timely and appropriate judgements on audit findings and translate into needed actions and follow up plans
• Demonstrated ability to effectively communicate with stakeholders regarding coding and documentation improvement
• Commitment to producing high quality analysis and attention to detail
• Excellent verbal/written communication skills
• Keen interest in healthcare compliance and healthcare policy
• Excellent time management, attention to detail, follow up skills, organizational skills, and ability to prioritize work and meet deadlines
• Proficient user in MS office suite: reputed company, Outlook, PowerPoint, Word. A desire to expand those capabilities is required, as is the ability to train others to use such tools
• Preference will be given to candidates who are certified in medical auditing, certified in healthcare compliance, and/or reputed company or former licensed clinicians (e.g., RN)

Company Overview