Professional Fee Auditor - Remote

Job Description:

At e4health, we Empower Better Health. The e4health Team is on a relentless mission to care for those teams who care for others. We bring our passion, ingenuity, and expertise to every engagement. In joining our Team, we want your help to provide our customers with powerful solutions in the pursuit of quality, integrity, clinical and financial value across healthcare.

Our People make the difference. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. e4health solutions streamline clinical, financial, and health information data and workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at www.e4.health.

The Medical Coding Integrity Specialist, Professional Fee - Remote

JOB SUMMARY:

The Medical Coding Integrity Specialist, Professional Fee is responsible for completing quality assurance reviews on internal or external professional coding specialists or external providers. This may also include onboarding audits and training of newly hired e4health coding specialists. This role is responsible for validating the coding specialist is accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, Evaluation and Management Guidelines, and CMS directives. The Coding Integrity Specialist also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding specialist, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Medical Coding Integrity Specialist is expected to maintain consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

• Completes all regularly scheduled quality assurance reviews for clients
• Completes onboarding quality assurance reviews and training on all newly hired consultants
• May perform training to newly hired coding consultants
• Communicates quality issues to management as appropriate
• Assists with identification of, drafting, implementation, and monitoring of quality improvement action plans for coding consultant
• Maintains reports and accuracy rates for coding consultants and clients as appropriate
• Responds to client QA needs at the direction of management
• Provides coding consultants educational sessions on error trends as requested by management
• Notifies management when there is a compliance concern or incident
• Demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
• Promotes confidentiality and using discretion when handling patient information
• Attends educational conference calls
• Provides coding support to the business as needed
• Performs other duties as needed with the project
• Maintains required productivity and quality requirements
• Maintains coding credential requirements
  
  

REQUIRED QUALIFICATIONS:

• Candidate must possess an approved AHIMA or AAPC coding credential
• Minimum 4 years’ coding experience required; specialty experience may be preferred as per specific client needs
• Minimum 2 years of auditing experience preferred
• Extensive education and training of 2021 Evaluation and Management guidelines

KEY SUCCESS ATTRIBUTES: 

• Integrity, passion, and ethics are required
• Demonstrates strong collaboration skills
• Has strong analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment 
• Demonstrate excellent interpersonal as well as well-developed written,verbal, and presentation communication skills including deep listening and attention to detail
• Ability to self-motivate and self-direct
• Possess strong time management and organizational skills
• Commitment and adherence to company Core Values

CORE COMPETENCIES:

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability
• Meeting Standards

BENEFITS: 

We offer an excellent salary, full benefits package including 401(k) with company match and discretionary profit sharing, group medical, dental, vision, life, & short-term disability insurance, and PTO policy. 

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS: 

Sitting, talking, hearing and near vision are required over 90% of the time. Feeling is required over 90% of the time and reaching is required about 50% of the time.  Ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS: 

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations. 

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position.