As our Coding Quality Associate-Profee (auditor) you will be responsible for reviewing coded cases for coding completeness and accuracy. Everyday you will identify potential coding and DRG errors, research appropriate guidelines to support recommended changes, and communicates the changes to the coder involved on a timely basis. To thrive in this role you must have your CCS or CPC and have profee coding experience.
Responsibilities:
Audits records as defined in the coding quality review plan. Review cases flagged by the coding quality software on a daily basis for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition and DRG assignment
Perform retrospective coding quality reviews as requested
Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) so as to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines
Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues
Maintains both a high productivity rate and a high accuracy rate in accordance with established auditing standards
Serves as an inpatient coding expert & resource for the coding teams and other departments
Works with the Regional Manager to identify areas of educational need based on audit results
Reports to, and works with, the Regional Manager to identify improvements in the audit software tool, workflow processes and flag management; and assist with evaluation and testing of audit applications and updates as needed
Work with the hospital’s CDI team to address and resolve documentation issues
Assists with compilation, generation and analysis of data for results reporting and performance Improvement initiatives
Contributes to the reduction of the hospital's and Company’s coding compliance risks and contributes to the Company’s revenue enhancement goals
Maintains an open dialogue and a good working relationship with team members in order to advance the mission and objectives of the hospitals and R1
Assists with training of new auditors. Assists with other audits and duties as requested
Required Qualifications:
CCS or CPC designation
A minimum of seven (7) years of professional fee coding experience
CPMA preferred
Extensive knowledge of ICD-10-CM/PCS classification system and MS-DRG and APR-DRG methodologies is required
Expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines along with CMS and other agency directives for ICD-10 coding
Must have proficient MS Office computer skills, specifically in Excel and knowledge of various coding software/platforms and EMRs
Must be detail-oriented and have the ability to work independently and maintain a high productivity rate and coding accuracy rate
Ability to interact with other employees through effective communication
For this US-based position, the base pay range is $20.91 - $38.39 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
Learn more about Benefits (http://go.r1rcm.com/benefits) at R1
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:
Comprehensive Medical, Dental, Vision & RX Coverage
Paid Time Off, Volunteer Time & Holidays
401K with Company Match
Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
Tuition Reimbursement
Parental Leave
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)
To learn more, visit: R1RCM.com
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R1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups.
Our mission is to make healthcare simpler, so providers and patients can focus on what matters most. R1’s proven and scalable operating models seamlessly complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. Our priority is to always do what is best for our clients, patients, and each other.
Headquartered near Salt Lake City, Utah, R1 employs over 27,000 people globally and is traded on the Nasdaq stock exchange under the symbol “RCM.”