Coding Auditor

Description

At Wellvana Health, our mission is to reduce healthcare costs and improve outcomes by empowering providers to succeed with value-based care. We do this by reducing the administrative complexities placed on physicians, helping them to prioritize patient relationships and quality of care.
 

Our team shares one common desire that drives every decision we make: We believe that Wellvana can be a catalyst for systemic change that reimagines and simplifies healthcare, making it easier to practice, access, and navigate.

This remote auditing position will report directly to the Director of Auditing. This role requires the ability to perform ongoing internal quality assurance audits of in-house coders, providers, and outside vendors as assigned.  These audits will be used to set companywide objectives/goals, identify deficiencies, and ensure compliance. The ideal candidate will be proficient at abstracting appropriate diagnosis from supporting documentation in the medical record as well as assuring that performance measures are being properly reported.  These ongoing audits will be performed in order to assure that submitted ICD-10-CM codes are fully supported by the clinical documentation and are being coded to the highest specificity. Auditor will participate in various special projects stemming from results of previous audits and report any improvement or nonengagement. Initial audits of new practices will be assigned in order to determine how providers can best be supported. Auditor will analyze findings of completed audits to determine coding error trends and make recommendations for process improvements to prevent their reoccurrence. Must have up to date knowledge of quality performance measures and risk adjustment methodology.

Responsibilities:

• Use critical thinking skills to determine any deficiencies in provider documentation, proper coding, and performance reporting. Ability to abstract codes from claims data, diagnostic testing, labs, specialist, and hospital notes. Assure that all ICD 10 codes assigned are coded to the highest specificity and are supported in the medical record.
• Document clear, and accurate results based on current coding guidelines for any errors or omissions on audit spreadsheet, with particular focus on missed opportunities related to patient care. Record potential risk opportunities based on complete chart reviews, suspect reports, and open Gap reports.
• Quantify and report data found according to established protocol. 
• Must be able to identify any potential areas of noncompliance to include fraud, abuse, incorrect coding according to government guidelines. Auditor will report findings to supervisor to investigate and implement corrective steps when necessary
• Perform quarterly Quality Assurance reviews on internal coders and outside vendors. Maintain logs of findings. All coding entities as well as members of audit team will be required to maintain an accuracy rating of 95% while meeting productivity requirements
• Monitor and report error trends to target educational opportunities. Able to communicate audit results with providers and coding team effectively 
• Commit to conduct all audits according to established ethical standards and assure accurate coding in accordance with all regulatory requirements.

Qualifications:

• Preferred Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC)
• Strong time management and organizational skills. Able to meet assigned deadlines
• Knowledge of proper ICD-10-CM, CPT, and HCPCS coding guidelines and principles
• Experienced with various EMR systems
• Knowledge of medication classes, anatomy, physiology, disease interactions, medical terminology
• 3 years- HCC/Risk adjustment experience 
• 3 years- Auditing experience
• Knowledge of industry and governmental regulations/guidelines to include individual payer rules of proper reporting.