The RCM CPC Auditor and Educator is responsible for auditing the providers' coding and documentation to effectively provide feedback and education. They will provide training tools and tips to new and existing providers, as well as ongoing group training opportunities.
The RCM CPC Auditor and Educator is responsible for building relationships with our external physicians while conducting medical record reviews, monitoring, analyzing coding patterns, and providing virtual education. Provide coding expertise as well as administrative oversight to improve the overall quality of the documentation; ensuring that it is to the highest level of specificity in accordance with the CMS guidelines.
Responsibilities
- Comfortable and confident to communicate coding requirements to physicians/providers so that physicians understand what/how to document for the services they are performing
- Audits and educates providers and coders on a quarterly schedule.
- Creates coding education curriculum to train providers how to document and understand how documentation relates to codes.
- Conducts virtual meetings with providers to provide one on one or group training and education
- Creates an auditing system to effectively audit findings and deliver outcomes.
- Validates provider documentation for accuracy by reviewing and analyzing samples of coding and claims extracts compared to actual medical records.
- Develops education materials to assist physicians in accurately assessing patients’ overall health status.
- Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
- Maintains a comprehensive tracking and management tool for assigned physicians within Advantia Health provider network.
- Identifies issues, and reports results timely to ensure that physicians remain in compliance.
- Presents progress and results to leadership on a routine basis.
- Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
- Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
- Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff in Coding and Documentation including CMS Models, Clinician Chart Reviews, and Encounter Documentation.
- Suggest customizations of coding and documentation for various audiences; Support Staff, Providers, Specialists, and Employees.
- Stays current on industry coding, compliance and HCC issues.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
Qualifications
- Proven experience as a CPC
- Familiarity with all CMS guidelines
- Working knowledge of MS Office and databases
- Excellent communication and interpersonal skills
- Ability to handle sensitive, confidential information
- Self-starter, with the ability to work independently and resourcefully.
Job Requirements:
- 2+ years of Athena experience and or super user
- Certified Professional Coder and Registered Health Information Technician (RHIT)
- At least 10 years in profee coding/auditing/education experience for OBGYN specialties: maternal fetal medicine, complex OB, Mammography. Needs strong surgical experience and E&M Leveling
- 5-7 years' experience within Revenue Cycle
- Effective Communication, presentation and project management
- Excellent problem solving, written and verbal communication skills, with the ability to clearly explain technical reasoning.
- Proficient experience in computer technology, including Microsoft word, PowerPoint and Excel.
- Strong Training and evaluative skills
Please note: Advantia Health provides unparalleled healthcare to our customers by employing the most highly qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.
Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage EOE M/F/D/V.
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What We Do
Advantia is transforming healthcare for all women - we’re setting a higher standard of care and convenience while reducing unnecessary costs. Compassion and value inspire everything we do. We take time to listen, answer questions completely, and offer helpful technology between visits so that our patients are empowered and at ease. Alongside coordinated care, Advantia is pioneering care models that align incentives with the best interests of women and their families.
