20 days old

Medical Coding Auditor - Outpatient

Sunrise, FL 33351
Regular Full Time

As a member of our medical audit team, the Medical Coding Auditor - Outpatient will have an opportunity to make a direct contribution to the companys bottom line in our rapidly growing healthcare business. You will leverage your coding knowledge, and medical claims experience to identify client records with billing coding issues as well as investigative and auditing opportunities.
You will help identify and refine new issues for Performant to present to our clients for audit strategy, proof of concept development, and assist in developing training material or assist in training for new issues. You must possess a unique blend of medical coding experience, business aptitude and understanding of payables/receivables, commitment to excellence, critical eye for quality and accuracy, team spirit and the self-drive to meet and exceed productivity goals. 

You must enjoy spending time solving puzzles, researching, and giving attention to detail. Your depth in knowledge of medical billing standards and systems, and adaptability applying those skills will allow you to have an immediate impact to the team. Candidates who will thrive in this collaborative environment enjoy variety in their work and are willing to learn new systems and client requirements, anytime and anywhere. 

If you are ready to use your strengths in medical coding, keen eye for identifying issues, and passion for excellence in a new way, this is the job for you!  Performant Financial Corporation is a provider of technology workflow management solutions for various government, healthcare and financial services markets. We focus on audit and recovery services through our proprietary technology platform, combined with robust data analytics and experience gathered through decades of proven processes. 

Our base technology, workflow management processes and data management are flexible and extensible, as proven by our ability to service complex and competitive markets.  Performant is committed to:
Accurate auditing of payment streams
Efficient recovery of past due receivables
Intelligent management of financial assets
We provide services in highly regulated arenas in the public and private sector and we are committed to work in compliance with the laws and regulations that govern the industries we serve.

What you will do:
Objectively and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity and quality expectations.
Conduct review of flagged claims and Fraud Waster & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. 
Timely review and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding. 
Appropriately refer reviews for clinical validation,  and communicate with and provide guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements. 
Enter and update all contract and/or review findings a supporting documentation into the audit processing system.
Write logic/parameters for system edits to detect incorrect coding over payments, aberrant and abusive coding patterns.
Proof of concept development and data analysis of reports for potential edit development.
Monitor CMS and major payer coding and reimbursement policies.
Assist in identifying new issues/investigative strategies for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation.
Maintain a current knowledge of all Medicare and Commercial regulations, policies and procedures, as well as requirements defined in assigned client(s) Statement(s) of Work (SOW).
Maintain certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certification(s), as well as HIPPA and other compliance training provided by Performant and client(s).
Develop and maintain professional working relationships within the department and cross-functionally.
Notify management of:
* all correspondence indicating displeasure with the Remittance Advice (RA), in the over payment identification, or in the recovery methods utilized,
* legal action, or 
* government intervention
Assist in developing material for training and facilitate or assist in audit training sessions.
Assist in educating Performant team members on coding, policies, regulations, appeal strategies, etc. as needed.
Attend conference calls and meetings as requested.
Demonstrate Performants company core values as a member of the team in performing ones role:
*People respect for others, diversity and professionalism in communications and conduct
*Innovation adaptability, and flexibility in applying skills in our dynamic business environment. Creativity and open minded in solving issues in our teams, in development and delivery of our products, and for our clients.
*Excellence commitment to compliance, quality and achievement of business goals and results for our clients and for our business.
Perform miscellaneous duties as assigned required to meet business needs in a highly professional manner

Physical Requirements
Professional business setting, sits at a desk using keyboard, mouse and monitor to perform work. Headsets provided upon request. Works assigned schedule based upon business needs (full-time 8 hours per day/ 40 hours per week, and work extended hours/overtime as required to meet business needs) and requires:
Able to work in face paced professional business environment 
Able to sit at desk, working on computer and phones 
Lift/carry/push/pull under and over 10lbs occasionally
Keying frequency, handling, reaching, fine manipulation
Repetitive use of right/left arms and hands

Required Skills and Knowledge:

Possess knowledge of CMS rules and regulations
Proficient in the use of MCS 1500/UB 04 forms
Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10, MS-DRG coding
Working knowledge of encoder
Proven ability to review, analyze, and research coding issues
Reimbursement policy and/or claims software analyst experience
Familiarity with interpreting electronic medical records (EHR)
Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing
Courteous, professional, and respectful attitude
Adaptability of skills to handle any non-standard situations that may arise or apply skills in new ways as may be required to meet business needs
Ability to multi-task effectively and work independently in a remote setting 
(*Must have acceptable home internet connection and meet requirements of Performant Teleworking Policies for remote work eligibility) 
Attention to detail
Excellent written and verbal communication skills
Typing skills, comfortable navigating and using desktop technology, as well as working knowledge of MS Office applications (Outlook, Word, Excel).


Education and Experience:

Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
3+ years of direct experience in coding/auditing outpatient services, and medical chart review for all provider/claim types for outpatient. Coding for emergency care highly desired.  
Some inpatient coding/auditing experience for hospital, physicians office or clinical setting for inpatient services preferred. 
Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.

Performant Financial Corporation is an Equal Opportunity Employer.
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration protected by law. Performant will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.

Employment Visa Sponsorship is not available for this position and authorization to work in the United States is required prior to employment.

Remote work/relocation assistance is not available for this position.

Drug/Alcohol Free Workplace:
Performant Financial Corporate is committed to maintaining a Drug and Alcohol Free Workplace. Candidates that have been offered employment will be required to submit and successfully pass a drug and alcohol screening. Drug and alcohol screening for current employees may be performed in certain circumstances in accordance with company policy and applicable laws.

Background and Credit Checks:
Performant Financial Corporation will procure a background criminal and credit history report on you in connection with your application for employment as allowed under the Fair Credit Reporting Act. These reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by Performant Financial Corporation, throughout your employment or contract period.

Agency Submissions:
Performant Financial Corporation does not accept unsolicited agency resumes. Please do not forward resumes to Performant employees. Performant Financial Corporation is not responsible for any fees related to unsolicited resumes.


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Posted: 2020-10-09 Expires: 2020-11-29
Analytics, audit, and recovery services for healthcare, government and student loans.

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Medical Coding Auditor - Outpatient

Performant Financial
Sunrise, FL 33351

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