Job description

eCatalyst Healthcare Solutions is hiring immediately for a Professional Fee Auditor. In this role you are responsible for reviewing medical record documentation to determine accuracy of ICD-10-CM, CPT, HCPCS, CPT modifiers and E&M codes. As a Professional Fee Auditor, you will perform auditing for our internal team and our valued client partners.

Essential Functions/Position Requirements

• Completes position functions in a way that mirrors the values of eCatalyst.
• Responsible for consistently delivering eCatalyst’s brand promise “Exceptional services delivered with unrelenting client focus.”
• Provide client services and lead, coordinate, and perform all functions of quality reviews for PB coding across multiple clients in multiple specialty groups and settings.
• The PB Auditor performs quality reviews on coders ensuring compliance with coding guidelines and company policies for complete, accurate, and consistent coding.
• The Professional Fee Auditor will assign and sequence ICD-10, CPT/HCPCS Level II codes, including E/M leveling, and all appropriate modifiers through review of documentation and diagnostic results as appropriate for billing, internal and external reporting, research, and regulatory compliance.
• Knowledge expert and maintains up-to-date working knowledge of coding guidelines to act as a resource and point person for issues and question for coders, customers, or project teams.
• Provides education to audit clients or internal eCatalyst coders as required by the deliverables of the contract.
• Reviews physician documentation for coding appropriateness and accuracy following AMA and other national and state approved coding and billing guidelines.
• Knowledge of billing/edit practices preferred.
• Reviews and analyzes medical records for accurate code selection.
• Provides feedback to coders and providers on coding corrections, appropriately citing authoritative resources.
• Assists with the interpretation of codes and other information requested for accurate code assignment.
• Communicate with management regarding clinical, coding, and reimbursement issues as needed.
• Function in a professional, efficient, and positive manner with strong critical thinking and decision-making skills.
• Utilizes our client’s electronic medical record (EMR), encoder, and computer-assisted coding (CAC) software as directed.
• Ensures optimal reimbursement while maintaining compliance with CMS and third-party payor policies and guidelines.
• Maintains compliance with eCatalyst and client’s coding policies, procedures, and guidelines.
• Consistently maintains 95% or above accuracy rate while meeting established productivity standards. There may be client specific quality and productivity standards and the employee is responsible for understanding the expectations.
• Accurately and ethically completes daily production log and daily time keeping requirements.
• Attends and participates in eCatalyst and client meetings as requested.
• Completes coding continuing education and maintains auditing credentials.
• Always ensures HIPAA compliance.

Required Education and Experience

• 3+ years of professional fee coding experience.
• 3+ years of professional fee auditing experience.
• 3+ years auditing the following specialties, including but not limited to the following: Breast Care, Cancer Care, Cardiology, Cardiothoracic Surgery, Colon & Rectal Care, Gastroenterology, General Surgery, Maternal-Fetal Medicine, Neurosurgery, Orthopedics, Pain Management, Pediatrics, Post-Acute Care, Primary Care, Pulmonary Services, Thoracic Surgery, Urogynecology and Women's Health
• Experience with physician clinic auditing required and hospital facility clinic auditing is preferred.
• Experience working in a coding vendor company or large hospital system is preferred.
• Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite.
• Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
• Consistently achieves quality and productivity standards.

Job Type: Full-time

Pay: From $32.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift

Experience:

• PB Coding: 3 years (Required)
• PB Auditing: 3 years (Required)

Work Location: Remote

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