CPMA Educator, Auditor

This is a fully remote position, open to applicants in New Mexico.

📋 Description

• Assist in the execution and adherence to coding policies and procedures across the organization and specific departments.

• Conduct and oversee internal audits and reviews to evaluate compliance in coding, documentation, billing, and clinical coding.

• Monitor internal audit outcomes for PHS.

• Deliver training across the organization for coding, auditing, and clinical personnel.

• Facilitate corrective action plans through auditing and training initiatives.

• Review medical records and billing for precision; identify inconsistencies and suggest remedial actions.

• Address and carry out medical record assessments requested by external regulatory bodies and insurance providers.

• Act as a point of contact for Information Services, Finance/Patient Financial Services, hospitals, medical group sites, health plans, home health, ambulance services, compliance, and auxiliary departments.

• Stay updated on clinical documentation standards and legal/regulatory requirements.

• Investigate coding, billing, and charging compliance matters; propose and execute corrective action plans.

• Contribute to the CDQA Annual Audit Work-plan.

• Respond to daily inquiries related to coding and auditing, and perform ad-hoc analyses for management.

• Maintain a comprehensive understanding of PHS coding and auditing IT systems.

• Collect and analyze data to provide recommendations.

• Conduct training sessions on coding, documentation, and compliance, including education on EPIC EMR clinical documentation.

• Assist with external defense audits.

• Perform targeted internal medical record audits to ensure accurate coding, billing, and charging.

• Analyze and communicate audit results and findings to management.

• Investigate patient care and billing issues.

• Monitor reports and quality audits to guarantee that clinical coding functions adhere to standards.

⛳️ Requirements

• An associate's degree is required; alternatively, 3 years of relevant clinical healthcare experience can be considered in place of a degree.

• A minimum of 2 years of experience in clinical healthcare is necessary.

• RN and auditing experience are preferred.

• Required knowledge of medical terminology, ICD-9, CPT-4, and HCPCS.

• Strong understanding of Medicare, Medicaid, and other third-party payer documentation, coding, and billing regulations for assigned service lines.

• Proficient in computer applications, particularly Microsoft Word, PowerPoint, and Excel.

• Must be willing to travel to all PHS locations, including overnight trips.

• Working hours may fluctuate based on assigned projects.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Short-term and long-term disability insurance.

• Group term life insurance.

• Optional voluntary benefits.

• Employee Wellness rewards program.

• Gift cards and other rewards for participation in wellness activities.