Job Information
CareOregon Coding Auditor - Payment Integrity in Portland, Oregon
Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.
Job Title
Coding Auditor – Payment Integrity
Exemption Status
Exempt
Management Level
n/a
Direct Reports
n/a
Manager Title
Payment Integrity Manager
Department
Operations
Pay and Benefits
Estimated hiring range $71,340 - $87,200 /year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes
This is a fully remote role, but you must reside in one of the listed 9 states.
Job Summary
The Coding Auditor performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department.
Essential Responsibilities
Perform and assist with a variety of coding-related audits for providers and other entities.
Assist with RADV and other diagnosis code related audits. (Applies to Finance department roles only.)
Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data.
Communicate audit results and recommendations for improvement to providers when needed.
Create and maintain processes for tracking audit results and outcomes of reviews.
Identify, track, analyze and report on any trends revealed in audits.
Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders.
Develop or assist with the development of educational materials and process documentation in a variety of mediums (e.g., recorded training sessions, reference documentation, etc.)
Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations by frequently referencing current ICD-10-CM and CMS manuals, reviewing professional publications, and attending educational workshops/conferences.
Maintain active coding certification.
Seek out emerging coding best practices using a variety of strategies (e.g., establishing personal networks, participating in professional associations, etc.)
Serve as subject matter expert regarding correct coding practices.
Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 2 years’ experience as certified coder
Active coder certification through AHIMA or AAPC
Preferred
Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO)
Experience leading group educational presentations and teaching to medical professionals
Experience with or knowledge of risk adjustment principles (applies to roles in Finance/Risk Adjustment department)
Knowledge, Skills and Abilities Required
Knowledge
Extensive knowledge of diagnosis coding conventions as defined by CMS and AMA
Skills and Abilities
Ability to read and comprehend medical terminology and medical chart notes
Ability to work proficiently with electronic health record (EHR) software systems
Strong computer skills, including ability to learn new systems and applications as needed
Strong skill and ability to use Microsoft office products (PowerPoint, Excel, Word, etc.)
Ability to use SAS, SQL, Tableau or other analytic software (helpful, but not required)
Analytical, problem-solving and research skills
Proficient written and spoken communication skills
Ability to effectively teach and coach adult learners and communicate technical information clearly
Ability to present information to groups, including medical professionals
Strong attention to detail and problem-solving skills
Ability to work autonomously with a high degree of initiative
Ability to work well under pressure, remain focused and meet deadlines
Ability to use good judgment and discretion to perform job responsibilities
Ability to adhere to organizational standards, policies and procedures
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
#MULTI
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
