Provider Audit and Quality Assurance Specialist, Coding Quality and Education

Role: Provider Audit and Quality Assurance Specialist, Coding Quality and Education

Location: Remote. Must work in a location within the United States.

Travel: No travel required.

Classification: Hourly, Non-Exempt

Reports to: Coding Quality and Education Leadership

Salary Range: Commensurate with experience

About the role

The Provider Audit and Quality Assurance Specialist is responsible for executing standardized audit programs, including reviewing coded accounts to ensure appropriate code selection, delivering provider and coder education, and ensuring adherence to established coding guidelines and regulatory requirements.  They’re able to analyze information, validate accuracy, and provide feedback to coders and providers alike.  These team members have an eye for detail and an aptitude for accuracy, but they take it one step further to provide regular verbal and written feedback, recommendations, and education to others.

Responsibilities

• Performs validation reviews for coding compliance, quality, accuracy and completeness.
• Reviews coded accounts to ensure codes were selected appropriately.  This is inclusive of ICD-10-CM diagnosis codes (to their highest specificity and sequencing), ICD-10-PCS and DRG assignment for inpatient facility coding, CPT procedure codes, E&M codes, HCPCS and modifiers for outpatient coding.
• Reviews and analyzes audit findings for both providers and coding professionals to identify trends, risk areas, and educational opportunities.
• Prepares coding quality reports / feedback for distribution to individuals (providers and coders), teams, and revenue cycle leadership.
• Assists with the documentation of coding policies and procedures (including educational materials and tip sheets) that may be used for Revology and / or client benefit.
• Provides training and education to coders and providers to improve coding quality performance for the team(s) under their responsibility.
• Works collaboratively and effectively with internal and external partners, including providers, coding and revenue cycle leadership to identify opportunities; supports improvement or optimization initiatives when assigned.

• Proactively identifies operational, documentation, or system issues impacting coding accuracy or compliance. Works with cross-functional teams and leadership to develop and implement effective solutions.
• Complies with and holds with utmost regard all compliance requirements to protect patient privacy and confidentiality (HIPAA compliance); abides by the Standards of Ethical Coding.
• Stays curious, kind and contributes positively to the Revology culture. The health + harmony of the team is everybody’s responsibility at Revology.

The statements stated in this job description reflect the general duties as necessary to describe the basic function, essential job duties/responsibilities, job requirements, physical requirements and working conditions typically required, and should not be considered an all-inclusive listing of the job.  Individuals may perform other duties as assigned, including work in other functional areas to cover absences or relief, to equalize peak work periods or otherwise balance the workload.

Requirements

• Certified Coding Specialist (CCS) license or similar from a nationally accredited medical coding organization required; Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) accepted.  
• Minimum five (5) years of medical coding and/or coding quality experience.
• Minimum three (3) years of multi-specialty medical coding auditing experience required.
• Understanding of all or a combination of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, including coding compliance guidelines.
• Must remain current on coding guidelines, rules and regulations, and new codes.  Must complete mandatory continuing education.

• Ability to work independently to accomplish goals in a dynamic environment.
• Excellent communication skills (verbal and written) required to support interactions with internal and external partners.
• High school diploma or equivalent required; bachelor’s degree or equivalent experience preferred.

Remote work requirements

Internet capability must be a high-speed internet connection of 40 Mbps speeds or greater.

Physical requirements

Must be able to perform physical activities, such as, but not limited to: moving or handling (lifting, pushing, pulling and reaching overhead) office equipment and supplies weighing 1 to 25 lbs. unassisted.  Frequently required to sit for extended periods during the workday.  Manual dexterity and visual acuity required.  Must be able to communicate effectively on the telephone and in person.

Working conditions

Work will generally be performed indoors in an office environment.  Must maintain a professional appearance and manner.  

Employment eligibility

Candidates must be legally authorized to work in the United States without sponsorship.