Risk Adjustment Coding Auditor

Job Description:

Provides advanced-level expertise in the areas of national physician code sets, insurance reimbursement, coding compliance issues, and internal coding policies, procedures and processes, to employed and contracted Intermountain secondary care physicians, advanced practice clinicians, their managers and staff.

Job Located in Nevada. Selected candidate must live in Nevada

Scope
The Senior II Professional Coding Consultant is responsible for providing general expertise in the areas of national physician code sets, reimbursement, and coding compliance to Intermountain secondary care physicians, APC's, and staff, through work in the pre-bill portion of the clinical documentation and coding review and education process. This position ensures quality of audits and helpline responses by lower level consultants, and also plays an instrumental role in the training and development of new consultants.
The Senior II Consultant has a strong understanding of clinical processes and assigned specialty practices, and works with providers to develop tools to assist with their specialty's coding issues. Their experience gives them the ability to present to multi-specialty groups of providers, as well as the competence to attend and comprehend national coding seminars.
Job Essentials
1. Provides prospective (pre-billing) coding reviews to Intermountain secondary care physicians and staff.
2. Develops and presents prepared single and multi-specialty technical and process-based clinical documentation and coding education for physicians, managers and staff.
3. Provides specialty specific coding expertise in various fields including NCCI edits, PPRVUs, common labs and drugs, and physiology and anatomy.
4. Actively participates in resolving questions from the Medical Group Coding Helpline for assigned specialties.
5. Develops new tools within assigned specialties to simplify coding content to ensure more consistent system-wide adherence to coding guidelines.
6. Supports higher-level senior consultants in their responsibilities and acts as an overflow in support of other departmental processes and functions as assigned.
7. Responsible for the development and training of junior-level consultants.
8. Performs non-scored technical quality reviews of junior-level consultant work. Utilizes findings to provide feedback and mentoring to junior-level consultants.
9. Effectively manages assigned area(s) or responsibility and workload.
10. Attends national coding seminars, assesses presented content against internal policies and procedures, and then ensures dissemination and implementation of updates/changes to assigned clinics.
11. Provides understanding and correct application of general and specialty-specific ICD and CPT guidelines in assigned specialties.
Minimum Qualifications
CPC or equivalent national professional coding certification.
Bachelor's Degree in a related field such as Business Administration, Health Care Administration, Health Administration Services, or Public Health. Degree must be obtained through an accredited institution. Education is verified.
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Six years of experience as trainer, educator, or consultant.
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One year of experience in coding or auditing.
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One year of experience in a role requiring subject-matter expertise in consulting on coding-related issues.
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Demonstrated understanding of medical terminology, medical acronyms, anatomy and physiology, knowledge at a specialty-specific level.
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Demonstrated excellent written/verbal communication and presentation skills.
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Ability to travel.
Preferred Qualifications
Master's Degree in a related field such as Business Administration, Health Care Administration, Health Administration Services, or Public Health.
Three years of experience in a risk specific role consulting on coding-related issues.
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Experience with calendaring, email, word processing, and spreadsheet applications, Centricity Business (IDX), Help2, iCentra, and Microsoft Access.
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Understanding of, and experience in, Professional Coding and Reimbursement department policies, procedures, and guideline interpretations.
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Competence in the utilization of Professional Coding and Reimbursement department tools, databases, and reports to track progress on assigned projects and produce meaningful information for provider practices.

Physical Requirements:

• Interact with others requiring the employee to communicate information.

• Operate computers and other office equipment requiring the ability to move fingers and hands.

• See and read computer monitors and documents.

• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Pay range: $32.77 - $51.61 Depending on experience

Location:

Nevada Central Office

Work City:

Las Vegas

Work State:

Nevada

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$32.77 - $51.61

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.