Facility Outpatient Auditor (Part Time)

Are you interested in joining one of the nation's leading providers of medical coding services that is experiencing impressive year-over-year growth?  Aviacode is nationally recognized as one of the top medical coding companies in KLAS and Black Book Market Research surveys.  Here is your opportunity to be part of this exciting team.  We are hiring now and have an immediate need for an Outpatinet Auditor.

The Outpatient Auditor is responsible for assigned auditing projects and assisting clients in maintaining compliant auditing operations. These projects include, but are not limited to auditing, instruction/education, reimbursement theory, clinical documentation opportunities/improvements, as well as use and interpretation of data analytics. 

• Develops and provides ongoing training/education to support application and adoption of ICD-10-CM/PCS coding and documentation concepts for internal and external coders.
• Auditing-OP Audits to include: Responsible for accurate data entry into the Audit tool, if applicable. Responsible for review of all medical record documentation in order to validate correct reporting of services provided.  Responsible for validating complete physician order for all outpatient services. The components of a complete physician order include diagnosis/diagnoses; date and time order was written/entered; specification of service to be provided, valid physician authentication including date and time order was authenticated.  Responsible for validating that service ordered was provided and billed with appropriate HCPCS code(s).
  • Responsible for researching and reviewing all applicable Local Coverage Determinations (LCDs) for appropriate FI/MAC as well as CMS National Coverage Determinations (NCD) in order to evaluate appropriateness of reimbursement received.
  • Responsible for validating that all data elements transferred from the charge entry and coding systems to the UB-04 and to the payor’s claims processing system.  Responsible for validating appropriate payment was received by the client upon adjudication of the claim.
• Responsible for providing education and feedback to clients after audit is completed.  Responsible for staying current with CERT, MAC, RAC and other entities targeted subjects.  
• Validating accuracy and completeness of all medical record documentation; validating that service was ordered, provided and reported with appropriate code(s); all data elements transferred from the charge entry and coding process through the billing system and the payor’s claim processing system, including validation that appropriate payment was received by the client upon adjudication of the claim.
• Researching and reviewing all applicable coverage determinations/policies in order to evaluate medical necessity and resulting appropriate reimbursement; follow all reporting rules (e.g., NCCI, modifiers) and correct coding rules. Coordinates and provides education content, financial impact information and other statistical reports, as well as conducting an education session and exit conference for client after audit is completed.  Insures that appropriate person (e.g., compliance officer, attorney, etc.) is apprised of all potential compliance risk areas if/as they are identified.  Responsible for maintaining knowledge regarding current target subjects as identified by CERT, MAC, RAC, etc., as well as Official Coding Guidelines, AHA Coding Clinics, HCPCS code updates, NCCI updates, OPPS updates.
• Provides, if required, continuing education to internal and external clients regarding changes to coding and reimbursement systems.
• Assumes personal responsibility for professional growth, development and continuing education in order to maintain a high level of proficiency.
• Maintains confidentiality of all types of protected health information and personally identifiable information.
• Mentors team members in areas to promote team work and elevate skill sets.
• Other duties as assigned

• Certified as RHIT, RHIA, CCS, CDIS, CDIP
• Should have ED, ANC, SDS, OBS including charge review (Obs hours, ED leveling, Injection and Infusion) coding and auditing experiece. 
• Direct experience with and knowledge of hospital revenue cycle, auditing, and/or coding validation.
• Expert knowledge of ICD-10-CM Modifiers, NCCI, LCD, and OCE, ICD-10-PCS knoweldge perferred 
• Experience with presentation of education and/or audit results to high level hospital representatives. Ability to communicate effectively with physicians and other clinical disciplines.
• Thorough knowledge of medical terminology, anatomy and physiology and pathophysiology.
• ICD-10- CM and CPT/HCPCS expertise is required
• Remote work experience preferred
• Advanced Microsoft office user (Power Point, Excel, Word)
• Interest in Data Analytics
• Ability to travel and be reimbursed for travel expenses upon submission of expense report and approval by client and Aviacode.
• Experience in any of the following areas a plus: UR, Case Management, CMS, OIG, or RAC
• Good communication skills both written and verbal required
• This is a remote position anywhere inside the U.S. with flexible hours for about 10-15 hours per week.
• Computers will be provided as needed.