medical coding auditor

Alignment Healthcare

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This is a remote position. 
The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).
GENERAL DUTIES/RESPONSIBILITIES: 
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding &amp; abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality &amp; performance improvement standards are maintained, achieved &amp; improved per department policies and procedures. 
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS. 
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation, data flow integrity, UAT testing, high cost / low risk score members, retrospective chart reviews, or other risk adjustment related data review as directed by Manager. 
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement. 
5. Utilizes, protects, and discloses Alignment Healthcare patients&rsquo; protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 
6. Ensures compliance with all applicable federal, state &amp;local regulations, as well as with institutional/organizational standards, practices, policies &amp; procedures.
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding, compliance, and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications. 
8. Other duties as assigned to meet the organization&rsquo;s needs.
Job Requirements:
Experience:<ul><li>Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required</li><li>Preferred:</li></ul>
Education:<ul><li>Required: High School Diploma or GED. Completion of a Medical Coding training program.</li><li>Preferred: Bachelor&rsquo;s degree in Business Administration, health Care Management or in a related field</li></ul>
Training:<ul><li>Required: Technical School or courses that are required to become a certified coder.</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Knowledge of</li><li>
Proficient user in MS office suite &ndash; Excel, Word, Outlook</li><li>
Previous use of Epic, Allscripts, EZCap</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul>
Licensure:<ul><li>Required: Certified Coder required, CCS, CCS-P, CPC, or CRC</li></ul>
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $64,384.00 - $96,577.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

MRA Coding Auditor - Remote

Xtensys Connected Health solutions

<div><h4 class="jobSectionHeader">Who We Are</h4>
Xtensys is a rapidly growing managed service provider delivering innovative technology solutions to health systems, beginning in New York and expanding nationwide. Owned by two industry leaders with a strong focus on advancing rural and community healthcare, Xtensys is executing several major initiatives and scaling quickly. With a team of more than 500 professionals, we are building a people-centered culture rooted in collaboration, innovation, and strategic thinking.

We are seeking an experienced Medical Coding Auditor to support our continued growth and commitment to deliver exceptional client outcomes.
<h4 class="jobSectionHeader">
Why Join Us?</h4>
Mission-Driven Work: You are the &quot;bridge&quot; ensuring technology serves health systems and their patients when they need it most.

Autonomy and Ownership: We trust you. You&rsquo;ll lead projects, define success, and manage complexities with total support.

A Culture of Innovation: Have a fresh perspective? We want it. We encourage risk-taking and continuous improvement.

Continuous Growth: We fuel your &quot;restless curiosity&quot; with opportunities to expand your skillset and mentor others.
<h4 class="jobSectionHeader">
The Role:</h4>
Your Mission: As our next Professional Insurance Collector ll, you will assist the team in resolving patient accounts to get claims paid properly and quickly by working with the insurance company, thus reducing the outstanding accounts receivable for Xtensys. A successful Professional Insurance Collector will have strong computer skills, be comfortable with medical terminology, are organized and thrive in a highly structured environment. Members of the Revenue Cycle team work independently but are flexible and collaborative to ensure that the department&rsquo;s goals are met.
<h4 class="jobSectionHeader">
What You&rsquo;ll Do Day-to-Day:</h4>
Maintain and manage Epic work queues, including Follow-Up and Denial work queues, ensuring timely and effective handling of all items within these queues to support efficient claims processing and account resolution.

Reviews credit balances for overpayments. Refunds are done timely.

Handles any correspondence including rejections on a timely basis.

Interacts and works closely with other departments of the Medical Centers.

Maintains a working knowledge of all billing functions, procedures and regulations.

Research problems relating to patient accounts, including working with other departments concerning billing issues.

Engage with patients and payers via phone to address and resolve issues related to accounts, ensuring effective communication to facilitate prompt resolution.

Identifying problematics trends and communicating with department leaders.

Researches, identifies, and rectifies any special circumstances affecting the resolution of the account.

Meets established quality and productivity goals set by management.

Is responsible for attending all mandatory education programs as required.

Maintains confidentiality and adheres to all HIPAA guidelines and regulations.

It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties which may be assigned.

Who You Are &amp; What You&rsquo;ll Bring
<h4 class="jobSectionHeader">
Proven Track Record:</h4>
3-5 years of billing and insurance collections in a healthcare environment.

Working knowledge of all billing functions, procedures and regulations.
<h4 class="jobSectionHeader">
Education/Certifications:</h4>
High School Diploma or GED required. Associate&rsquo;s degree or Coding Certification preferred.
<h4 class="jobSectionHeader">
Technical Savvy:</h4>
Revenue Cycle Systems Knowledge: Understanding of billing platforms and claim workflows

Experience with Epic is a plus.

Travel Requirements: No travel required

Physical Readiness: Capability for sedentary work, including sitting for long periods
<h4 class="jobSectionHeader">
About Xtensys Connected Health Solutions</h4>
We are new but mighty. Xtensys, a recently established managed service provider, delivers cutting-edge technology to health systems, starting in NY and expanding beyond. Owned by two industry leaders focused on innovation in rural and community health, we are rapidly growing with several major initiatives underway. We seek talented professionals to join our team of 500 and support our exciting journey. We value people and are building a culture to match. If you're a collaborative, innovative, and strategic leader, we&rsquo;d love to talk.</div>

Professional Insurance Collector ll

MCS HEALTHCARE HOLDINGS, LLC

<div>Evaluador(a) De Perfiles De Salud 
Regular
Non-Exempt 
GENERAL DESCRIPTION:
Responsible for evaluating CHRA (Comprehensive Health Risk Assessment) forms received from Classicare policyholders and coding the documented clinical information according to the guidelines established by the Unit.
ESSENTIAL FUNCTIONS:<ul><li>Performs coding of diagnoses documented in the CHRA (Comprehensive Health Risk Assessment) and registers the data into the appropriate application. Identifies and informs the Supervisor about areas of opportunity to avoid errors that reduce rejected data and may represent a risk to compliance with established coding guidelines.</li><li>Works on post-payment audits of adjudicated claims based on the information contained in the Comprehensive Health Risk Assessment comparing it to the information required, following the operational guidelines established by the unit.</li><li>Generates referrals throughthe electronic app used in the Unit with providers and/or billing representatives, related to CHRA document management, to guide them and/or request correction of medical diagnoses due to incorrect coding, and inadequate, ambiguous, or incomplete medical documentation.</li><li>Process adjustments received for corrections in the CHRA, following the established operational guidance.</li><li>Identifies claims that require the support of the Claims and/or Providers department to be processed.</li><li>Provides weekly, monthly, and quarterly reports to the supervisor on audits performed as required.</li><li>Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.</li><li>May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.</li></ul>
Minimum Qualifications:
Education and Experience: Two (2) years of college education equivalent to sixty (60) approved credits from an accredited university or an Associate degree. At least one (1) year of medical billing experience with ICD-9 and ICD-10 coding.
OR
Education and Experience: Associate Degree in Health Information Management Technology from an accredited university. At least six (6) months of experience performing clinical billing and coding processes.
&ldquo;Proven experience may be replaced by previously established requirements.&rdquo;
Certifications / Licenses: A valid Medical Billing Certification and/or ICD-9, ICD-10, and/or other health-related Certifications are preferred.
Other: Knowledge of medical billing processes and ICD-9-CM, ICD-10-CM coding.
Languages:
Spanish &ndash; Intermediate (comprehensive, writing and verbal)
English &ndash; Intermediate (comprehensive, writing and verbal) 
&ldquo;We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.&rdquo;</div>

Evaluador(a) De Perfiles De Salud

CorroHealth

<div>About Us: 
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
Serves in a consulting role by evaluating the work of client&rsquo;s coders in their assignment of ICD-10, CPT and/or HCPCS codes to hospital inpatient, outpatient and/or physician practice encounters. Performs concurrent or retrospective reviews to inventory code assignments and report the data to the client. Develops and delivers educational content to clients related to audit findings. 
 
Must have 5+ years of auditing in professional fee (profee) with E/M leveling 
Coding certification through AHIMA or AAPC required (CPC, COC, CIC, CCS, RHIT, RHIA) 
 
This is a remote position
ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member&rsquo;s performance objectives as outlined by the Team Member&rsquo;s immediate Leadership Team Member.
Essential Functions:<ul><li>
Perform complex, concurrent and/or retrospective analysis of medical record documentation to Validate coded data as recognized by the AHA, CMS, AMA, AHIMA, AAPC, Coding Clinic, and CPT Assistant within the professional fee billing model.</li><li>
Analyze findings and identify potential root causes of produced errors.</li><li>
Prepare summary reports of findings to clients, supplying specific references supporting findings contained within the provided audit report.</li><li>
Provides second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.</li><li>
Research, analyze, and respond to inquiries regarding compliance, coding, and denials.</li><li>
In all situations, protect the privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines and compliance practices, standards, and procedures.</li><li>
Functions as a member of the Consulting Services Team which develop and provide coding education to clients.</li><li>
Conduct Audits as assigned meeting the productivity standards as set by record type for each audit.</li><li>
The threshold for billable productive hours, when client work is available, is expected to be at or above 80%.</li><li>
Prepare deliverables for the client as required for the audit scope while meeting timelines.</li><li>
Conduct independent QA of their assigned audit results prior to final submission for QA review and approval.</li><li>
The minimum accuracy expectation is 95%.</li><li>
Report work time and work products in a timely and accurate manner.</li><li>
Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.</li><li>
Interact with clients in a professional manner that, always, exhibits excellent relationships, work performance and communication skill so as to support the company and its business interests.</li><li>
Provide schedule of planned work activities, events and sites, and any changes to same, to Management and appropriate staff.</li><li>
Maintenance of professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.</li><li>
Other duties and responsibilities, as assigned.</li></ul>
Knowledge, Skills &amp; Abilities:<ul><li>
Recognized credential from AHIMA or AAPC.</li><li>
Experience with telecommuting and electronic medical record systems required.</li><li>
Strong analytical skills.</li><li>
Proficient computer skills, specifically Microsoft Office products.</li><li>
Strong team player.</li><li>
Ability to work with multiple and diverse clients and projects.</li><li>
Ability to work with minimal supervision.</li><li>
Ability to maintain and access multiple files.</li><li>
Assure that work product is completed with high levels of accuracy and attention to detail.</li><li>
5+ years&rsquo; experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document, or other relevant experience.</li></ul>
This is a remote position
PHYSICAL DEMANDS: 
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. 
A job description is only intended as a guideline and is only part of the Team Member&rsquo;s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.</div>

Auditing & Education Consultant- Professional Fee

BILLING & CODING COMPLIANCE ANALYST

AMPLA HEALTH

<div>GENERAL PURPOSE:
The Coding Research and Training assistant is responsible for providing medical coding training and support for providers and staff based on needs identified by the Corporate Compliance Officer/Health Information Manager.
MAIN RESPONSIBILITIES &amp; DUTIES:<ul><li>
Works with Revenue Cycle, Operations and Clinical departments to provide provider and staff trainings including but not limited to the following areas:<ul><li>
ICD-10 application and guidelines</li><li>
Evaluation and Management selection</li><li>
Centricity Practice Solution training specific to ICD 10-and procedural coding</li><li>
Auditing of provider diagnosis, procedural coding and documentation.</li></ul></li><li>
Acts as a resource for questions related to HCPCS, CPT and ICD 10-coding.
</li><li>Evaluates the record for documentation consistency and adequacy during provider coding audits. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.</li><li>
Researches codes and guidelines as it pertains to various providers, Informatics, billing and other departments as requested, to give accurate information for the purposes of billing, reporting and auditing.
</li><li>Assist in auditing, reviewing and reporting to appropriate parties, any findings on various audits done within the oversight of the Compliance program.</li><li>
Assists with training for all departments involving ICD-10-CM and CPT CM including, but not limited to Evaluation and Management section, Centricity Practice Solution.
</li><li>Collects and records data accurately on training received by staff.</li><li>
Trains in various clinical areas (Suboxone, HIV, 340B drugs etc.) to be audited to fully understand the policies and procedures for each area in order to assess, audit and report findings to the Compliance officer.</li><li>
Maintains audit records for outside auditing purposes as well as further internal auditing purposes.
</li><li>Prepares for audits by researching materials, policies, procedures and formulating a plan of action. Setting up spreadsheets for data and recording as required.
</li><li>Communicate audit progress and findings by preparing reports and providing information in meetings when requested.
</li><li>Assists the Compliance/Coding/HIM lead in reporting, educating, creating and implementing any policy and procedure necessary to ensure that all departments follow regulations according to the Compliance program.
</li><li>Assist the Compliance Officer with onsite audits as needed.</li><li>
Enhances compliance department and the organizations reputation by accepting responsibility for accomplishing new and different coding and compliance related requests; exploring opportunities for additional audits/monitoring to ensure the most robust compliance program possible.
</li><li>Also assists with the coding and HIM department with patient complaints, records requests, incident reports, correcting claims as requested by the Coders, and other duties as assigned.
</li><li>Travel as needed</li><li>
Maintains open communication with supervisor and all staff.</li><li>
Maintains confidentiality of all patients/personnel records.</li></ul>
QUALITIES &amp; CHARACTERISTICS<ul><li>
Maintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla Health&rsquo;s staff, Board of Directors and vendors</li><li>
Maintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actions</li><li>
Strives to learn more and is receptive to learning different ways of doing things</li><li>
Displays enthusiasm toward the work and the mission of Ampla Health
</li></ul>PROFESSIONAL KNOWLEDGE, SKILLS &amp; ABILITIES<ul><li>
High School Diploma or GED</li><li>
Approved Coding certificate required. (CCS, CPC)
</li><li>Experience working in a compliance role preferred, but not required</li><li>
Knowledge of billing practices, auditing practices, various programs utilized in an outpatient clinic setting.
</li><li>Prior medical records review experience</li><li>
Experience in governmental programs as related to FQHC&rsquo;s or other related clinical setting</li><li>
Centricity practice management system experience is a plus</li><li>
Data management responsibilities a plus</li><li>
Able to operate general office equipment, such as copiers, facsimile machine, etc.
</li><li>Working knowledge of Microsoft windows programs such as Word, Excel, Power Point</li><li>
Intermediate computer skills</li></ul>
COMMUNICATION SKILLS:<ul><li>
Must have neat and legible handwriting</li><li>
Must be able to interact with patients/providers courteously and calmly</li><li>
Ability to communicate well with the public</li><li>
Exceptional verbal and written communication skills</li></ul>
WORKING CONDITIONS &amp; PHYSICAL REQUIREMENTS
Works well with patients, co-workers and vendors in a generally comfortable environment office. Employee must possess the following physical requirements:<ul><li>
May require prolonged sitting or standing</li><li>
Travel as needed</li><li>
Vision sufficient to read handwritten, typed and computer printed documents throughout the day</li><li>
Speech and hearing sufficient to receive and communicate detailed information clearly by phone and in person</li><li>
Motor skills sufficient to use and manipulate equipment</li><li>
Must have a high level of manual dexterity</li><li>
Physically able to sit, walk, or otherwise stand for long periods of time, frequent bending, stooping, and stretching. Repetitive hand, arm, and shoulder movements</li><li>
Able to lift up to 40 pounds</li></ul>
GENERAL PURPOSE:
The Coding Research and Training assistant is responsible for providing medical coding training and support for providers and staff based on needs identified by the Corporate Compliance Officer/Health Information Manager.
MAIN RESPONSIBILITIES &amp; DUTIES:<ul><li>
Works with Revenue Cycle, Operations and Clinical departments to provide provider and staff trainings including but not limited to the following areas:<ul><li>
ICD-10 application and guidelines</li><li>
Evaluation and Management selection</li><li>
Centricity Practice Solution training specific to ICD 10-and procedural coding</li><li>
Auditing of provider diagnosis, procedural coding and documentation.</li></ul></li><li>
Acts as a resource for questions related to HCPCS, CPT and ICD 10-coding.
</li><li>Evaluates the record for documentation consistency and adequacy during provider coding audits. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.</li><li>
Researches codes and guidelines as it pertains to various providers, Informatics, billing and other departments as requested, to give accurate information for the purposes of billing, reporting and auditing.
</li><li>Assist in auditing, reviewing and reporting to appropriate parties, any findings on various audits done within the oversight of the Compliance program.</li><li>
Assists with training for all departments involving ICD-10-CM and CPT CM including, but not limited to Evaluation and Management section, Centricity Practice Solution.
</li><li>Collects and records data accurately on training received by staff.</li><li>
Trains in various clinical areas (Suboxone, HIV, 340B drugs etc.) to be audited to fully understand the policies and procedures for each area in order to assess, audit and report findings to the Compliance officer.</li><li>
Maintains audit records for outside auditing purposes as well as further internal auditing purposes.
</li><li>Prepares for audits by researching materials, policies, procedures and formulating a plan of action. Setting up spreadsheets for data and recording as required.
</li><li>Communicate audit progress and findings by preparing reports and providing information in meetings when requested.
</li><li>Assists the Compliance/Coding/HIM lead in reporting, educating, creating and implementing any policy and procedure necessary to ensure that all departments follow regulations according to the Compliance program.
</li><li>Assist the Compliance Officer with onsite audits as needed.</li><li>
Enhances compliance department and the organizations reputation by accepting responsibility for accomplishing new and different coding and compliance related requests; exploring opportunities for additional audits/monitoring to ensure the most robust compliance program possible.
</li><li>Also assists with the coding and HIM department with patient complaints, records requests, incident reports, correcting claims as requested by the Coders, and other duties as assigned.
</li><li>Travel as needed</li><li>
Maintains open communication with supervisor and all staff.</li><li>
Maintains confidentiality of all patients/personnel records.</li></ul>
QUALITIES &amp; CHARACTERISTICS<ul><li>
Maintains a professional relationship and positive attitude with co-workers, the public, patients and all Ampla Health&rsquo;s staff, Board of Directors and vendors</li><li>
Maintains the highest professional ethics and is honest in dealing with people; is a model for all employees through his/her actions</li><li>
Strives to learn more and is receptive to learning different ways of doing things</li><li>
Displays enthusiasm toward the work and the mission of Ampla Health
</li></ul>PROFESSIONAL KNOWLEDGE, SKILLS &amp; ABILITIES<ul><li>
High School Diploma or GED</li><li>
Approved Coding certificate required. (CCS, CPC)
</li><li>Experience working in a compliance role preferred, but not required</li><li>
Knowledge of billing practices, auditing practices, various programs utilized in an outpatient clinic setting.
</li><li>Prior medical records review experience</li><li>
Experience in governmental programs as related to FQHC&rsquo;s or other related clinical setting</li><li>
Centricity practice management system experience is a plus</li><li>
Data management responsibilities a plus</li><li>
Able to operate general office equipment, such as copiers, facsimile machine, etc.
</li><li>Working knowledge of Microsoft windows programs such as Word, Excel, Power Point</li><li>
Intermediate computer skills</li></ul>
COMMUNICATION SKILLS:<ul><li>
Must have neat and legible handwriting</li><li>
Must be able to interact with patients/providers courteously and calmly</li><li>
Ability to communicate well with the public</li><li>
Exceptional verbal and written communication skills</li></ul>
WORKING CONDITIONS &amp; PHYSICAL REQUIREMENTS
Works well with patients, co-workers and vendors in a generally comfortable environment office. Employee must possess the following physical requirements:<ul><li>
May require prolonged sitting or standing</li><li>
Travel as needed</li><li>
Vision sufficient to read handwritten, typed and computer printed documents throughout the day</li><li>
Speech and hearing sufficient to receive and communicate detailed information clearly by phone and in person</li><li>
Motor skills sufficient to use and manipulate equipment</li><li>
Must have a high level of manual dexterity</li><li>
Physically able to sit, walk, or otherwise stand for long periods of time, frequent bending, stooping, and stretching. Repetitive hand, arm, and shoulder movements</li><li>
Able to lift up to 40 pounds</li></ul></div>

Coding Research & Training Assistant

Doctors Urgent Care Group

Job Summary:The Medical Billing Quality Assurance Officer is responsible for executing internal audit protocols across the medical billing and coding lifecycles. This professional monitors charge capture, claim form fields, modifier placements, and Accounts Receivable (AR) follow-up processes to ensure strict alignment with CMS guidelines, HIPAA regulations, and payer-specific policies. By analyzing error trends and delivering targeted coaching, the QA Officer actively minimizes claim denials, lowers Days Sales Outstanding (DSO), and shields the healthcare organization from structural compliance risks.Core Duties and Responsibilities:<ul><li>Routine Claims &amp; Process Audits: Conduct random and targeted internal audits on submitted claims, payment postings, and patient statements across multiple source systems (EHR/Billing software) to measure accuracy against established Service Level Agreements (SLAs).</li><li>Code Verification &amp; Compliance Tracking: Validate that applied ICD-10-CM, CPT, and HCPCS codes accurately reflect the clinical documentation. Screen pre-submission claims for upcoding, undercoding, unbundling errors, and missing modifiers using NCCI (National Correct Coding Initiative) edits.</li><li>Denial &amp; Rejection Root-Cause Analysis: Review clearinghouse rejections and insurance denials to pinpoint structural workflows or system glitches. Trend the data by team or individual to implement long-term corrective action plans.</li><li>Staff Feedback &amp; Coaching: Package audit metrics into clear, actionable reporting dashboards. Conduct standard calibration sessions and retraining with medical billers, coders, and AR specialists to reduce performance deficiencies.</li><li>Payer Guideline Management: Maintain an updated knowledge base of evolving state/federal regulations (Medicare, Medicaid) and commercial insurance policies. Ensure internal Standard Operating Procedures (SOPs) are updated to match quarterly code changes.</li><li>AR and Ledger Integrity Reviews: Meticulously review accounts receivable follow-up records to confirm that staff are properly appealing denials, managing outstanding balances ethically, and applying payment plans appropriately.</li></ul>Required Skills and Qualifications:<ul><li>In-Depth RCM Expertise: Comprehensive understanding of the end-to-end insurance claim lifecycle, commercial/government clearinghouse procedures, and medical terminology.</li><li>Advanced Coding Literacy: High proficiency interpreting guidelines within ICD-10-CM, CPT, and HCPCS codebooks, alongside a firm grasp of payer-specific bundling rules.</li><li>Data-Driven Analysis: Strong analytical mindset with the ability to define distinct billing problems, extract performance data, establish root causes, and draw objective conclusions.</li><li>Communication &amp; Collaboration: Diplomatic, plain-language interpersonal communication style. Able to deliver constructive performance evaluations to staff and translate technical compliance data clearly to leadership.</li><li>Software Proficiency: Hands-on experience navigating enterprise Electronic Health Record (EHR) databases and industry-standard billing platforms (e.g., Epic, Cerner, eClinicalWorks) alongside advanced proficiency in MS Excel for auditing logs.</li></ul>Education and Experience Requirements:<ul><li>Education: Associate&rsquo;s or Bachelor&rsquo;s degree in Healthcare Administration, Finance, Business, or a closely related field (or equivalent verified experience).</li><li>Experience: Minimum of 2 years of direct experience in medical billing, coding, or healthcare data auditing. Proven experience in an auditing or supervisory capacity is heavily preferred.</li></ul>Pay: Rs100,000.00 - Rs150,000.00 per monthWork Location: Remote

Medical Billing Quality Assurance (QA) Officer

Search 8162+ Medical coding auditor jobs near you this June. New roles added regularly across leading industries. Apply today.