Medical Coding and Compliance Auditor -CPC

Overview

Concentra is recognized as the nation's leading occupational health care company.

With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America's workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees.

The Auditor, Coding & Compliance - Occupational Medicine and Specialty will perform detailed coding and documentation audits and reviews to ensure compliance with clinical and coding guidelines. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one on one, and group education and training to employed and contracted clinicians. The Auditor will provide in-depth, real-time feedback on appropriate documentation, charge capture and Level of Service code selection. A thorough knowledge of state specific worker's compensation coding and billing guidelines is required for this position. The audit findings are compiled and analyzed and then the results scheduled and presented to the clinical by the auditor, via telephone of video platforms in accordance with the clinician's schedule.

Responsibilities

• Complete compliance audits for designated clinicians / centers consistent with established audit protocols and nationally recognized guidelines.
• Meet the production and QA standards as set out in Concentra Coding and Compliance policies.
• Analyze audit findings and identify / assess potential compliance risks related to coding and billing and notify clinical leadership regarding outliers.
• Organize and present the audit findings to each clinician as indicated by either the audit results, denial and down coding trends, and / or as requested by medical leadership, center leadership or Central Billing Office leadership
• Schedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises.
• Assist CBO's with reconsideration, appeals process and coding support as requested
• Participate in special projects and collaborate with other departments to support coding, auditing, and compliance initiatives.
• Provide clinician support, education and training related to the quality of documentation, level of service, procedure and diagnosis coding consistent with established coding guidelines and standards
• Collaborate with Medical Leadership in development of clinician training plans and for active support in the training process under guidance of coding leadership
• Monitor Coding and State Workers' Compensation changes to ensure that most current information is available
• Ensure adherence to all State and Federal guidelines applicable to coding, billing and documentation compliance for Worker's Compensation in all served markets

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Education Level : High School Diploma or GED

Certifications and / or Licenses :

Job-Related Experience

Job-Related Skills / Competencies

Additional Data

Employee Benefits :

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation, if required.

Concentra is an Equal Opportunity Employer, including disability / veterans