About the position
The healthcare system isn’t designed for health. We’re designed to change that. We’re Wellvana, and we help doctors deliver life-changing healthcare. Through our high-touch approach to value-based care, we're moving beyond fee-for-service and helping tie the healthy outcomes of patients directly to healthier profitability for providers and health systems. Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care that is nothing short of life changing. Named a Best Place to Work by Nashville Business Journal and featured in Insider’s 33 startups 'investors expect to take off in 2023,' we’re one of the fastest-growing companies in America because what we do works. This is the way medicine is meant to be.
Responsibilities
- Perform ongoing internal quality assurance audits of in-house coders, providers, and outside vendors as assigned.
- Abstract appropriate diagnosis from supporting documentation in the medical record.
- Assure that performance measures are being properly reported.
- Conduct audits to ensure that submitted ICD-10-CM codes are fully supported by clinical documentation and coded to the highest specificity.
- Participate in various special projects stemming from results of previous audits and report any improvement or nonengagement.
- Analyze findings of completed audits to determine coding error trends and make recommendations for process improvements.
- Document clear and accurate results based on current coding guidelines for any errors or omissions on audit spreadsheet.
- Record potential risk opportunities based on complete chart reviews, suspect reports, and open Gap reports.
- Quantify and report data found according to established protocol.
- Identify potential areas of noncompliance including fraud, abuse, and incorrect coding according to government guidelines.
- Perform quarterly Quality Assurance reviews on internal coders and outside vendors.
- Maintain logs of findings and ensure accuracy ratings of 95% while meeting productivity requirements.
- Monitor and report error trends to target educational opportunities.
- Communicate audit results with providers and coding team effectively.
- Conduct all audits according to established ethical standards and assure accurate coding in accordance with all regulatory requirements.
Requirements
- Must have a reliable and stable broadband internet connection with a minimum of 25 Mbps download and 3 Mbps upload speeds.
- Bachelor’s degree in a related field and/or the equivalent combination of training, education, and experience required.
- 3 years HCC/Risk Adjustment experience.
- 3 years Auditor experience.
- Strong time management and organizational skills.
- Knowledge of proper ICD-10-CM, CPT, and HCPCS coding guidelines and principles.
- Experienced with various EMR systems.
- Knowledge of medication classes, anatomy, physiology, disease interactions, medical terminology.
- Knowledge of industry and governmental regulations/guidelines including individual payer rules of proper reporting.
Nice-to-haves
- Certified Professional Medical Auditor (CPMA) certification preferred.
- Certified Risk Adjustment Coder (CRC) certification preferred.
- Certified Professional Coder (CPC) certification preferred.
