Remote CPMA Educator & Auditor
Presbyterian Healthcare Services · Remote Workers New Mexico · $60,986 (stated in the posting)
Location Address:
Remote Office
Santa Fe, NM 87501
Compensation Pay Range:
Minimum Offer $60,985.60
Maximum Offer $103,812.80
Now Hiring: Remote CPMA Educator & AuditorSummary:
With minimal supervision directly supports the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS; compliance to all external regulatory agency coding rules and regulations; Demonstrates high-level of proficiency in performing and/or managing internal audits or reviews to assess compliance/quality monitoring performed by PHS departments while serving as a resource on documentation, billing, and clinical coding compliance questions. tracking of internal audit results for all of PHS; enterprise-wide training of all PHS coding, audit, physician and clinician personnel; support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; insure the accuracy of defensive and proactive audits of medical records with billing and identifies and recommends actions related to discrepancies; responds and conducts medical record reviews requested by external regulatory agencies such as JCAHO, CMS and NMMRA as well as insurance companies such as PHP. Works on special clinical coding compliance related projects, disseminates information to PHS departments to maintain compliance with regulations.

Type of Opportunity: Full time
Job Exempt: Yes
Job is based: Remote Workers New Mexico
Work Shift: Days (United States of America)
Responsibilities:
- Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management.
- Maintain and apply current knowledge of standards of care in clinical documentation.
- Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form.
- Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, CPT-4, HCPCS and APC updates and changes.
- Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Identifies risks, develops and follows up on action plans, identifies lost revenue opportunities and any overpayments due to errors in coding and/or documentation, and provides compliance education.
- Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments.
- Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. Keeps actively informed on the business climate of the healthcare industry.
- Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management.
- Maintains up-to-date working knowledge of all PHS coding and auditing IT applications.
- Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group.
- Conducts training classes in areas of coding, documentation and compliance for PHS personnel. This includes preparation of training materials, educational audits and answering specific situational questions, and EPIC EMR clinical documentation education to providers and clinical staff.
- Assists with defense audits with external audit companies who represent third party payers.
- Conducts systematic focused internal audits via medical record review to insure correct coding, billing and charging as member of Enterprise-Wide Coding audit team.
- Analyzes and summarizes data from medical record and account audits and communicate results and findings to management.
- Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care.
- Ensures that clinical coding functions are performed in accordance with established quality and performance standards by monitoring system generated reports and quality audits.
- Working hours may vary based on projects assigned.
- Must be able to travel to all of the PHS sites (including overnight). Travel varies at certain times based on assignments.
Qualifications:
- Associates degree required, 3 years of additional clinical healthcare related experience can be substituted in lieu of degree.
- 2 years clinical healthcare related experience.
- RN and audit experience preferred.
- Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.
- Must have a proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for service lines(s) assigned.
- Must possess computer skills, especially with Microsoft Word, PowerPoint, and Excel applications.
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.