[Remote] Coding Compliance Analyst

Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. As a Coding Compliance Analyst, you will be responsible for procedure and diagnostic coding of professional charges, ensuring accurate and compliant coding and maximization of revenue through initial coding.

Responsibilities

• Participates in the identification and resolution of areas requiring additional intervention through established Coding/Billing and Corporate Compliance work plans
• Develops and implement clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through documentation/coding and billing compliance audits
• Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives
• Identifies trends that result in lost revenue and educates provider as appropriate
• Assist in the review and update of annual Revenue Integrity & Education work plan and audit schedule
• Performs formal review of annual CPT/Diagnosis/HCPCS changes and prepares educational documents by specialty highlighting significant changes
• Trains providers, staff, and others in small and large group sessions
• Meet deadlines, productivity targets as defined in the Coding/Billing Compliance work Plan
• Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, managers, physicians, and medical leadership
• Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations
• Conducts quarterly audits of Coding staff to ensure correct coding and to identify training opportunities
• Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership
• Works collaboratively with clinical department physicians, mid-level providers, and other staff to ensure appropriate and compliant documentation, coding, and billing practices
• Develops and tracks progress of internal audit schedules
• Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions
• Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third-party payer coding, specialty specific and reimbursement rules, and requirements
• Measures and reports coding trends as compared to national standards; or claim/documentation reviews. Documents and reports result to all appropriate parties
• Monitors and productivity reports and other data as requested by manager
• Participate in all governmental and third-party insurance audits
• Assist in developing Revenue Integrity and Education Policies and Procedures
• Comply with all established departmental policies, procedures, and objectives
• Maintains all Professional certifications
• Attends a variety of meetings as required or directed
• Performs other similar and related duties as required or directed
• Must be able to work as a team and independently as needed
• Regular, reliable, and predicable attendance is required

Skills

• High School Diploma/GED (or higher)
• Certified Professional Coder (CPC, CCS-P, CEMC, CPMA or COC)
• 1+ years of experience utilizing standard scoring (CMS) methodologies to report findings to providers
• 1+ years of experience employing clinical references with the auditing process
• 1+ years of experience with Apply CPT and ICD-10 coding convention to documentation guidelines
• 1+ years of experience with Apply CMS and other payer constraints to final code and documentation determination
• 1+ years of demonstrated experience in a physician/professional billing environment
• 1+ years of demonstrated experience with third party payer guidelines
• Ability to obtain CPMA within 1 year of employment
• Experience with ICD-10, CPT and HCPCS coding
• Experience with auditing physician medical records utilizing E+M guidelines
• Experience with Microsoft Office Suite (Excel, Word, Power Point) or successful completion of related courses. Must show proficiency in current billing software within six (6) months
• Demonstrated experience in the application of medical terminology, anatomy and physiology or successful completion of related college courses

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)

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