Description
First Class Solutions, Inc. is a health information management consulting firm with 36 years of serving the healthcare industry. We are seeking a seasoned, experienced outpatient/profee coding auditor. The individual will have no less than 5 years of facility outpatient and profee coding auditing and 7 years of outpatient and/or profee coding experience.
The individual may hold AHIMA and/or AAPC certifications. Auditing experience should include both facility outpatient and profee (inpatient/outpatient/rural health/physician office) skills. Excellent coding skills with both facility outpatient (all specialties) and profee (E/M) and the respective modifiers are required. Experience with anesthesia and dental coding is a plus.
A coding test will be administered.
Additionally, the ideal candidate will have knowledge of Medicare regulations relative to Profee coding (e.g., split billing, supervision, rural health, etc.) and would have worked in a compliance role at an academic center, integrated delivery system, and/or a multi-facility/group. Certified as a CRC, CEMC, CPCO, and/or CPMA is/are a plus. Experience with provider or facility billing rules also is/are a plus.
The ideal candidate will have well-honed presentation skills and be able to tactfully present audit findings virtually, or on occasion, in person with the client and/or the client's coding team. Additionally, this individual will prepare and present virtual or in person, education presentations for First Class Solutions' and its clients' coding teams. Typically, these presentations occur at the time of code changes (10/1, 1/1).
Experience with various EHRs and auditing tools is preferred. Expertise in Excel macros, creating complex formulas and functions, and creation of dashboards preferred.
When the individual is not auditing, the individual may perform production coding.
HYBRID: In-person/travel time is estimated to be less than 16 hours annually.
Preferred candidates will reside in Florida, Illinois, Indiana, Kansas, Maine, Maryland, Missouri, Ohio, Oregon, Pennsylvania or South Carolina.
Interested candidates should submit their resume, 2 professional references, and compensation expectations.
Requirements
The primary responsibilities of this position will be:
- Auditing Facility Outpatient Services (Ambulatory Surgery, Infusions, Observation, ER visits, Wound Care, Interventional Procedures, etc.) including the completeness and accuracy of diagnoses, procedures performed, modifiers assigned, and APC achieved.
- Auditing ProFee Visits (Inpatient, Outpatient, Practice Office, SNF, Rural Health, etc.) including the completeness and accuracy of diagnoses, procedures performed, modifiers assigned, and E/M assigned.
- Tactfully and completely providing coding guidance to the client coders and/or providers audited.
- Providing coding support to clients as needed.
- Being the "go to" person for the First Class Solutions coding team for outpatient coding questions.
Applicants must be a US citizen located in the continental US. Criminal check, drug screen, and E-verify will be utilized to validate individual's eligibility to work.
