[Hiring] Profee Auditor/Educator @Presbyterian Healthcare Services

Role Description

Build your Career. Make a Difference. Presbyterian is hiring a skilled Profee Remote Auditor/Educator to join our team.

Type of Opportunity: Full time

Job Exempt: Yes

Job is based: Remote Workers New Mexico

Work Shift: Days (United States of America)

Responsibilities:

• Supports the Coding and documentation quality assurance (CDQA) team with minimal supervision.
• Implements and ensures compliance with enterprise-wide and department coding policies and procedures for PHS.
• Ensures compliance with all external regulatory agency coding rules and regulations.
• Demonstrates proficiency in performing and managing on-site internal audits or reviews.
• Works on special coding compliance projects, develops and presents educational programs.
• Disseminates information to PHS/PMG departments and develops educational tools for compliance.
• Provides support via auditing and training for corrective action plans for coding and audit personnel.
• Performs medical record and billing reviews of denied and appealed claims.
• Coordinates review and tracking of appealed claims and communicates with affected payers.
• Researches and interprets all regulatory agency regulations.
• Liaison to various departments addressing functional coding, auditing, compliance, and training issues.
• Maintains accurate, complete, and timely documentation in electronic or hard copy form.
• Adapts to frequently changing work priorities and schedules.
• Maintains up-to-date technical knowledge of legal and regulatory information.
• Researches coding, billing, and charging compliance issues, recommends corrective action plans.
• Identifies risks, develops action plans, and provides compliance education.
• Assists in the creation of the CDQA Annual Audit Work-plan.
• Exercises independent judgment in determining the reliability of data reviewed.
• Responds to inquiries and requests regarding coding and auditing issues.
• Maintains up-to-date knowledge of all PHS coding and auditing IT applications.
• Gathers and analyzes information to address and resolve business issues.
• Conducts training classes in coding, documentation, and compliance for PHS/PMG personnel.
• Conducts systematic focused internal audits via medical record and charge ticket review.
• Analyzes and summarizes data from audits and communicates results to management.
• Researches and investigates customer concerns regarding patient care and billing.
• Ensures coding functions are performed in accordance with quality and performance standards.
• Working hours may vary based on projects assigned.
• Must be able to travel to all PHS/PMG sites, including overnight travel.

Qualifications

• High school diploma/GED required.
• Must possess at least one of the following licenses/certifications: RHIT, RHIA, CPC, CCS.
• Minimum of three (3) years experience in coding and/or auditing required; audit experience preferred.
• Excellent written and verbal communication skills.
• Detail and results oriented.
• Ability to work independently and make independent decisions.
• Knowledge of medical terminology, ICD-9, CPT-4, and HCPCS required.
• Proficient knowledge of Medicare, Medicaid, and other third-party payer regulations.
• Excellent organizational and planning skills.
• Computer skills, especially with Microsoft Word, PowerPoint, and Excel.
• Ability to use the internet and other resources for research purposes.
• Strong written and verbal communication skills to articulate complex regulatory information.
• Personal presence characterized by honesty, integrity, and the ability to inspire others.

Benefits

• Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits.
• Employee Wellness rewards program with opportunities to enhance health and well-being.

Company Description

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees, including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.