Qureos Mentor

Personalized Health Partners

<div>Job Address:
10123 Alliance Road, Suite 320 Blue Ash, OH 45242<h1 class="jobSectionHeader"> 
Medical Coding and Billing Compliance Auditor</h1>
Location: Remote 
Department: Coding Compliance 
Reports To: Director of Coding 
Employment Type: Full-time Exempt<h1 class="jobSectionHeader">
About the Role</h1>
The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation integrity and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of quality and compliance. The candidate will demonstrate a strong background in Microsoft Office applications including PowerPoint, Word, Excel, Outlook, TEAMS, and SharePoint. 
The Medical Coding Auditor will have a background in Physician feedback and education on documentation integrity and coding accuracy. The ideal candidate will have an extensive background and knowledge of CPT coding, ICD10CM coding, E&amp;M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to access Medicare Physician Fee Schedule (MPFS) tools including status indicators and what they mean, National Correct Coding Initiative (NCCI) manual and edits, Local and National Coverage Determinations (LCD and NCD), Coding Clinic, and CPT assistant. 
The ideal candidate will have knowledge of Skilled Nursing Facility (SNF) E&amp;M coding, Behavior Health coding, telehealth coding rules, HCC payment methodologies, and other specialty coding.<h1 class="jobSectionHeader">
Key Responsibilities</h1><ul><li>
Performs Coding audits for compliance and accuracy with all coding systems outlined in the role description.</li><li>
Completes coding compliance accuracy score tracking, trending, and monitoring.</li><li>
Completes detailed coding compliance reports which include feedback and education for providers.</li><li>
Maintains excellent documentation of all reviews, methodologies employed, results, escalation needed, and monitoring.</li><li>
Provide feedback and education to billers, coders, and providers on documentation and coding practices.</li><li>
Identify trends, errors, and compliance risks, and recommend corrective actions.</li><li>
Stay current on changes to coding guidelines, payer policies, and regulatory requirements.</li><li>
Collaborate with compliance, revenue cycle, and clinical teams to support audit outcomes.</li><li>
Assist with internal and external audit requests as needed.</li></ul><h1 class="jobSectionHeader">
Qualifications</h1>
Required:<ul><li>
Education: High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in Health Information Management or related field preferred.</li><li>
Certification: Current coding credential required (CPC, CEMC, CCS-P, RHIT, RHIA).</li><li>
Experience: 3+ years of outpatient coding experience required. 1+ years of audit, compliance, or quality review experienceStrong understanding of ICD-10-CM, CPT, E&amp;M, HCC, HCPCS, and official coding guidelines.</li><li>
Experience with EMR/EHR systems, encoders, and auditing tools.</li></ul>
Preferred:<ul><li>
Additional auditing certification (CPMA, CEMA, CDEO) preferred</li><li>
Leadership skills/experience</li></ul>
Skills &amp; Competencies:<ul><li>
Exceptional attention to detail and accuracy.</li><li>
Analytical Skills.</li><li>
Strong organizational skills.</li><li>
Strong written and verbal communication skills.</li><li>
Provider Education skills.</li><li>
Demonstrated ability to use technology and applications required for virtual teams.</li><li>
Ability to analyze data, identify trends, and recommend solutions.</li><li>
Knowledge of HIPAA, OIG, and other compliance regulations.</li><li>
Ability to work independently and manage multiple priorities.</li><li>
Performance Metrics</li>
Audit accuracy rate (goal<li> 95%).</li><li>
Timeliness of audit completion/productivity</li><li>
Provider and coder education effectiveness (measured by post-education improvement).</li><li>
Compliance with CMS and ICD-10-CM guidelines.</li></ul></div>

Medical Coding and Billing Compliance Auditor, Remote

<div>Job Address:
10123 Alliance Road, Suite 320 Blue Ash, OH 45242 
Nurse Practitioner, Adult and/or Gerontology
PHP Nurse Practitioners have a passion for delivering quality care to seniors and other residents in a variety of healthcare settings that can include, but are not limited to, skilled nursing facilities, assisted living, and independent living communities, as well as via telehealth.
PHP is currently recruiting Nurse Practitioners with a passion for delivering the highest quality care for our residents at Southbrook Healthcare Center located in Springfield, OH. Base Salary plus excellent Productivity bonuses paid out monthly!
Our Nurse Practitioners work Monday - Friday, 8a-5p. No call, no weekends or holiday coverage. Must be willing to work 5 days a week, Monday &ndash; Friday! 
Work in a supportive environment with ongoing educational opportunities to learn more about disease state management, palliative care practices, best practices in SNF care, and more.
Job Summary:
The Personalized Health Partners (PHP) NP is responsible for providing high quality primary care in a high touch, person-centered care model. The PHP NP practices to diagnose, treat, and manage acute episodic and chronic illness through wellness visits, early detection of change, and timely treatment. The Nurse Practitioner works in a collaborative model with the primary care provider and interdisciplinary team in the medical management of their member population and includes the members and their families in developing plans of care. This high touch model reduces hospital admissions and emergency room visits and leads a culture focused on customer experience and satisfaction.
Job duties &amp; responsibilities<ul><li>
Assess, diagnose, and manage chronic and acute conditions.</li><li>
Provide health education.</li><li>
Develop treatment plans and effectively verbalize those to residents and other appropriate providers, caregivers, etc.</li><li>
Order and interpret appropriate lab and diagnostic testing and adjust treatment plans accordingly.</li><li>
Maintain appropriate and compliant documentation within our EMR (electronic medical record) software.</li><li>
Collaborate with local and regional operations and clinical leadership to achieve goals.</li><li>
Support strategic initiatives regarding value-based care.</li><li>
Provide an excellent customer experience to foster high customer satisfaction/retention.</li><li>
Practice ethically and in accordance with the Scope and Standards of Practice of their profession and Board Certification.</li><li>
Follow all state and federal regulations, guidelines, and laws.</li><li>
Collaborate with PCP and interdisciplinary care team at facility.</li><li>
Coordinate care with other providers and specialists including telemedicine providers.</li><li>
Complete all regulatory required monthly, quarterly, and/or annual visits and acute visits as needed.</li><li>
Participate in family conferences and provide advanced care planning and education when needed.</li><li>
Address any pharmacy recommendations or pharmacist communications regarding residents.</li><li>
Providers are expected to be present in assigned facilities during work hours to ensure that facilities have adequate face-to-face coverage to meet resident care and facility needs.</li></ul>
Qualifications &amp; Experience requirements
Required:<ul><li>
Master of Science in Nursing, Doctor of Nursing Practice, or NP Certificate Program graduate</li><li>
National certification of AANP or ANCC</li><li>
Active, unrestricted state license</li><li>
Active DEA license</li><li>
US work authorization</li><li>
2+ years clinical experience as a Nurse or Nurse Practitioner in geriatric, adult or family practice setting</li><li>
Ability to work in a flexible environment and schedule</li><li>
Passionate about providing healthcare to the senior and low-income populations</li></ul>
Preferred:<ul><li>
Training or clinical experience in geriatrics</li><li>
2+ years clinical experience as a Nurse Practitioner</li><li>
Experience with coding, ICD-10 and HCC (Hierarchical Condition Categories)</li><li>
Experience or training working in a metrics, results driven healthcare model</li><li>
Be open to professional development through training, obtaining certifications if necessary, and attending team meetings</li><li>
Experience working in value-based care models</li><li>
Training or experience in geriatric, assisted living, and/or skilled nursing setting</li><li>
Experience working in a collaborative healthcare setting to drive positive outcomes and achieve goals</li><li>
Training or experience in outpatient primary care setting</li></ul>
Knowledge/Skills/Abilities<ul><li>
Must have strong oral and written communication skills</li><li>
Must be detail oriented with an ability to work well both independently and in a team setting</li><li>
Exhibit a customer service approach with teams and residents</li><li>
Strong time management skills required. Must be able to prioritize and adhere to competing deadlines while achieving goals</li></ul>
Benefits
As a PHP employee you will enjoy competitive wages and bonus opportunities. We offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. Added bonus opportunities.</div>

Nurse Practitioner, Adult and/or Gerontology

Join Personalized Health Partners and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

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Medical Coding and Billing Compliance Auditor, Remote

Nurse Practitioner, Adult and/or Gerontology