Facility Coding Quality Specialist (Auditor)

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: This is a REMOTE position. Must live in the United States. 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’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence Provides second –level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. Research, analyze and respond to inquiries regarding compliance, inappropriate coding, denials and billable services Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third part payer requirements, medical necessity requirements Protects the privacy and confidentiality of patient health and client information. Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. Suggests physician query opportunities query Physicians based upon documentation and clinical needs. Prepare deliverables for the coders as required Report work time and work productions in a timely and accurate manner Communicates with coworkers in an open and respectful a manner which promotes teamwork and knowledge sharing. Provide schedule of planned work activities, events and sites, and any changes to same to management and appropriate staff. Maintenance of professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education Monitor the on-going progress and success of each coder Maintain QA percentages within two internal quality goals; 1) overall minimum coder accuracy of 95% and 2) QA review percentages as close to 10% as…