Job description

We are hiring IMMEDIATELY for a Senior Coding Auditor and Training Specialist to join one of our community mental health providers!

Job Summary: This position is responsible for developing and leading a coding center of excellence (COE) group for Client to provide coding-related guidance to individuals and groups from multiple departments. Responsibilities include serving as a subject matter expert, collecting, consolidating, and preparing information for common use, and conducting training sessions. In addition to other coding guidance duties, the role conducts audits, identifies trends and reports on findings.

Essential Responsibilities-

• Develop and lead a coding COE group focused on providing a source of information and support for coding-related questions through meeting facilitation, Frequently Asked Questions (FAQ) documentation, etc.
• Provide training, best practices, and resources for internal coders.
• Assist with healthcare provider training regarding appropriate claims coding when/if necessary.
• Conduct internal claims coding reviews/audits of healthcare records and claims.
• Work with organization and development team and learning collaborative to utilize best practices, standards, and usage of the Learning Management System.
• Act as the subject matter expert for all coding case reviews and questions.
• Develop and conduct claims coding training sessions as needed for the claims Payment Integrity team.
• Review healthcare records to ensure they are complete, accurate and compliant with State/Federal regulations and Client policies.
• Prepare investigation/coding audit finding letters for healthcare providers and respond to any subsequent questions from them pertaining to the audit findings.
• Analyze claims coding data to identify coding error trends.
• Use knowledge of healthcare coding conventions to identify suspicious patterns in medical record documentation.
• Identify opportunities for improvement, risks to avoid, and methods to enhance internal controls across Claims, Clinical Operations, Enrollment and Payment Integrity departments (E.g., involving claims processing procedures, training, pre-payment focused claims reviews, etc.).
• Compile, publish and submit detailed reports
• Present findings and recommended solutions to management and business partners.
• Develop and maintain extensive recordkeeping of audit findings.
• Monitor coding information from various sources of communication from coding publishers and government agencies regarding coding practice changes in ICD-10-CM.
• Work in partnership with the fraud, waste and abuse (FWA) teams.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years’ coding experience
• Current coding certification from AAPC or AHIMA
• Active AAPC or AHIMA membership
• Experience conducting training sessions

Preferred

• Experience in provider-facing roles
• Experience conducting utilization management, especially within the Oregon Health Plan and/or the Centers for Medicare and Medicaid Services
• Behavioral health and/or dental coding experience
• Bachelor of Science in Nursing

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, Modifiers and NCDs
• Extensive knowledge of state and federal regulations/guidelines including CMS NCCI
• Thorough working knowledge of medical coding for all types (inpatient, outpatient, hospital, professional, laboratory, durable medical equipment, etc.
• Strong working knowledge of Microsoft products (E.g., Teams, Word, Excel, PowerPoint, etc.)

Skills and Abilities

• Ability to audit medical chart notes and identify incorrect coding
• Ability to abide by the Standards of Ethical Coding established by the American Health Information Management Association (AHIMA)
• Ability to develop training programs and resources
• Strong computer skills and ability to learn new systems and processes
• Strong planning and organizational skills
• Comfort communicating with all levels of management and employees

"Careers and companies flourish when staff, clients, and candidates truly believe in the mission, know the role they play, and humbly reflect, evaluate, and act for the best interest of the communities served"

Job Type: Full-time

Pay: $75,375.00 - $92,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• This position is remote for those living in WA/OR. Do you live or are you planning to relocate to Washington or Oregon?

Education:

• Bachelor's (Required)

Experience:

• ICD, CPT, HCPCS, APC, DRG, Revenue Codes, Modifiers and NCDs: 3 years (Required)
• knowledge of state/fed regulations/guidelines like CMS NCCI: 2 years (Required)
• Utilization management/Oregon Health Plan or Medicare-caid: 2 years (Required)

Work Location: Hybrid remote in Portland, OR

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