CPMA Educator, Auditor

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

📋 Description

• Assist in the implementation and adherence to coding policies and procedures across the enterprise and departments.

• Ensure alignment with coding rules and regulations set by external regulatory agencies.

• Conduct and/or oversee internal audits and quality assessments on-site.

• Act as a point of contact for inquiries related to documentation, coding, billing, and coding compliance.

• Engage in special projects focused on coding compliance.

• Create and deliver educational programs and resources.

• Audit and guide enterprise-wide corrective action plans for coding, auditing, and performance issues among physicians and clinicians.

• Evaluate denied and appealed claims and take necessary actions to secure accurate payments.

• Manage the review and tracking of appealed claims while communicating with relevant payers.

• Investigate and interpret regulations from regulatory agencies.

• Collaborate with Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance, and other ancillary departments.

• Keep current and distribute legal and regulatory updates, including ICD-9, ICD-10, CPT-4, HCPCS, and APC changes.

• Investigate coding, billing, and compliance issues and implement corrective measures.

• Identify risks, lost revenue potential, and overpayments stemming from coding or documentation mistakes.

• Assist in the development of the CDQA Annual Audit Work-plan.

• Address daily inquiries related to coding and auditing and respond to ad-hoc analysis requests.

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

• Collect and analyze data to propose solutions for business challenges.

• Facilitate training classes on coding, documentation, and compliance, including ICD-10 and EPIC EMR documentation education.

• Perform targeted internal audits by reviewing medical records and charge tickets.

• Analyze and convey findings from medical record and account audits to management.

• Devise strategies and processes to enhance coding efficiency and effectiveness.

• Investigate patient care and billing issues.

• Monitor reports and quality audits to ensure coding operations meet established quality and performance standards.

⛳️ Requirements

• High school diploma or GED is required.

• Must hold at least one of the following: RHIT, RHIA, CPC, CCS.

• A minimum of three (3) years of experience in coding and/or auditing is required.

• Audit experience is preferred.

• Outstanding written and verbal communication skills.

• Detail-oriented and results-driven.

• Ability to work independently and make informed decisions.

• Knowledge of medical terminology, ICD-9, CPT-4, and HCPCS is essential.

• Proficient understanding of Medicare, Medicaid, and other third-party payer documentation, coding, and billing regulations.

• Excellent organizational and planning capabilities.

• Capacity to prioritize multiple tasks and execute them accurately and concurrently.

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

• Ability to utilize the internet and other resources for research purposes.

• Skill in articulating complex regulatory information in layperson's terms.

• Must be willing to travel to all PHS/PMG locations, including overnight stays.

• Must be flexible with work hours based on project assignments.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Short-term disability coverage.

• Long-term disability coverage.

• Group term life insurance.

• Optional voluntary benefits.

• Employee Wellness rewards program.

• Gift cards and additional incentives through wellness activities.

• Participation in wellness challenges.

• Access to webinars.

• Preventive screenings.

• Full-time employment.