Coding Auditor (50552)

Who We Are:

Platinum Dermatology Partners is a network of high-quality dermatology clinics that focus on collaborative and innovative ideas to drive growth. We offer general dermatology, cosmetic, medical, plastic surgery, and cancer screening treatments. We have over 120 clinics, over 350 providers, and more than 2200 employees in clinics across Texas, Arizona, California, Nevada, and Florida. We are a rapidly growing company that allows our doctors to focus on providing exceptional care without worrying about the operational side of the business. Our core values focus on collaboration, ownership, respect, excellence, authenticity, and integrity. Our purpose is to empower the practice of exceptional dermatology.

Company Conformance Statements:

In the performance of their respective tasks and duties, all employees are expected to conform to the following:

• Perform quality work within deadlines with or without direct supervision.
• Interact professionally with other employees, customers, and suppliers.
• Work effectively as a team contributor on all assignments.
• Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations.

Position Summary:

The Coding Auditor will conduct coding, documentation, and billing audits to ensure compliance with state and federal coding standards. The role will also provide billing compliance education to providers and staff on proper coding and documentation requirements.

Essential functions/Responsibilities:

• Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings and proposing recommendations.
• Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
• Maintain excellent interdepartmental communication.
• Maintain excellent documentation of all reviews, methodologies employed, results, corrective actions implemented, and monitoring.
• Assist in response to billing audits by analyzing risk potential, assisting in medical record collection/submission, and appealing findings.
• Participate and represent the Coding Compliance and Audit Department on committees and in meetings when requested.

Job Specifications (KSAs):

· Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.)

· Minimum of five years’ experience in physician-based healthcare setting, preferably two of which in a coding quality and/or compliance auditing position.

· Knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, incident to guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles, and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.

· Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.

· Strong attention to detail and analytical skills, and the ability to interpret new laws and regulations, and communicate effectively both verbally and in writing.

· Ability to work in both independent contributor and team roles (both as a team leader and team member).

· As an Exempt Employee, ability to work varying hours and days as needed to complete tasks assigned by manager.

· Availability to travel if/when on-site provider education is requested.

Position Performance Criteria:

1. Quality/Compliance- committed to delivering consistent service and outcomes to the highest standard possible every time. Effective communication across the organization to ensure we are meeting all commitments and goals aligned with the company’s core values and competencies. Demonstrates overall professionalism in attitude, demeanor, and personal appearance.

2. Action/Result Oriented- takes on new opportunities and challenges with a sense of urgency, high energy, and enthusiasm. Consistently achieves results under tough circumstances. Follows through on commitments with honesty, integrity, and authenticity. Achieving and maintaining all productivity standards.

3. Honesty/Integrity- Gains the confidence and trust of others by exceeding our company and patient expectations. Builds partnerships and works collaboratively with others to meet shared objectives. . Exceptional service to internal and external customers. Demonstrates high reliability through consistent punctuality and attendance.

4. Resilience- Rebounds from setbacks and adversity when facing difficult situations. Is confident under pressure and can push through for results. Adapts to change with a positive attitude.

5. Plan/Align- Prioritizes work to meet commitments aligned with department, personal and company goals. Making good timely decisions within the employees’ area of responsibility that further the goals of the organization. Coordinates with other team members, including other departments, to resolve any issues that may lead to open or aging items- which may include RCM leadership when trends are identified or when an issue may need attention/escalation. Provides leadership, guidance and assistance to AR team members.

6. Follows HIPAA regulations and protects PHI.

Our competitive benefits package includes the following:

• Medical, Dental, and Vision insurance
• Short-term/Long-term disability
• Life and other voluntary plans
• 401(k) plan
• Employee Referral Program
• Paid Time-Off
• Company-Paid Holidays

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Physical Requirements: Must possess manual dexterity to operate office machines including computer and calculator; stooping and bending to handle files and supplies; and mobility to complete errands or deliveries. Includes handling of sharps and chemicals. Multiple staff demands and deadlines can trigger stress.

Equal Employment Opportunity:

Platinum Dermatology Partners is committed to a policy of equal employment opportunities for applicants and Employees. Employment decisions will comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, The Age Discrimination in Employment Act of 1967, the Americans with Disabilities Act of 1990, the Immigration and Nationality Act, the California Fair Employment and Housing Act, and all other applicable state and federal laws.

Platinum Dermatology Partners does not permit discrimination of any type against an employee because of any of the following legally protected characteristics: gender, race, color, religion, country of origin, mental disability, physical disability, marital status, gender identity, gender expression, ancestry, genetic information, medical condition, age, sexual orientation, or pregnancy.

Please note, that any offer of employment is contingent on the successful completion of pre-employment background checks.

No phone calls or agencies, please.