Senior Executive

Overview: Sr. Executive - Professional Audit- Surgery - Quality

1. The SENIOR EXECUTIVE CODING AUDITOR Quality performs quality auditing reviews, analyzes, and codes documentation from medical records that determines payments. This position performs highly technical and specialized functions, and the primary function of this position is to perform a thorough review of patient encounters to assess for completeness and accuracy of provider documentation and CPT and HCPCS coding. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
2. Perform analysis of data and understand the reasons for denial reasons, use appropriate codes to be used in documentation of the reasons for denials.

Qualifications:

1. Life science Bachelor's degree.
2. Para - medical background (B.PT, Pharm, and B.SC. Nursing)graduation is an added advantage.
3. Certification is added advantage - Certified coding professional coder (CPC) - AAPC OR Certified Coding specialist (CCS) - AHIMA
4. Working in quality team is preferable

Experience:

1. Minimum 5 to 8 years of Coding experience in multispecialty surgery.
2. Denial management experience is an added advantage.
3. Ability to apply analytical and critical thinking to review medical records.
4. Knowledge in CMS Medicare and Medicaid guidelines.
5. Specialty certificate (CPMA, CIRCC, CEDC) from - AAPC.
6. Para - medical background (B.PT, B.Pharm, B.SC. Nursing) graduation is an added advantage.
7. Auditing experience on multi-specialty.
8. Knowledge in Microsoft outlook/excel/word

Communication Skill:

Good communication skills

Working Hours:

9 Hours

Skills and abilities:

• Integrates coding principles in performance of medical audit activity and educates as needed on those principles.
• Upon completion of medical record audit, compiles detailed findings and prepares client reports, when needed.
• Coordinates with client to ensure patient data is received and processed for all scheduled audit work.
• Communicate proper volume to support invoicing.
• Provides feedback and process improvement recommendations to appropriate leadership team and participates in workgroups/committee meetings and process improvement solutions as required.
• Participates in and/or leads inter-departmental process improvement initiatives.
• Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.
• Identifies compliance risks and financial opportunities based on chart reviews.
• Prepares reports and executive summaries as required by management regarding audit results, process improvement recommendations, and systemic billing errors.
• Adheres to established productivity standards, participates in departmental performance improvement activities and work level.
• Communicates and works with all internal and external customers.
• Performs other duties as assigned