New York, New York 10036
Company Description
CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals : higher quality, lower cost, better outcomes.
Role Title : Revenue Integrity Coding Auditor and Educator
FLSA Category : Exempt
Role Location : Remote
Reporting Relationships :
This position reports to Director of Charge Capture & Coding.
Role Summary and Responsibilities :
The Revenue Integrity Coding Auditor is responsible for medical coding practices to accurately capture all appropriate ICD-10, CPT, and HCPCS codes to protect revenue and mitigate compliance risks. This position involves auditing clinical documentation, validating coding accuracy, educating staff on coding guidelines, and assisting with process improvements related to revenue cycle management.
Key Responsibilities / Essential Functions :
Revenue Integrity Support
- Collaborate with revenue cycle and billing teams to resolve coding-related denials and underpayments.
- Analyze denials to identify trends for revenue protection.
- Work with clinical departments to accurately capture documentation to support appropriate coding and reimbursement.
- Support process improvement initiatives to enhance revenue integrity and reduce audit risks.
- Support the implementation of policies and procedures that promote best practices in coding and revenue integrity.
- Stay current on coding regulations, payer guidelines, and industry standards to ensure the organization's adherence.
- Participate in internal and external compliance audits and assist with any follow-up actions.
Coding Audit and Analysis
Conduct regular and ad hoc audits of medical records and coding for accuracy, completeness, and compliance with regulatory guidelines (e.g., ICD-10-CM, CPT, HCPCS).Identify coding and documentation discrepancies and provide recommendations to address issues to protect or increase revenue.Prepare detailed reports on audit findings, highlighting opportunities for revenue recovery and recommendations for improvement.Monitor coding trends and variances.Education and Training
Develop and present educational materials and training sessions for internal and external customers (providers / team) to enhance their knowledge of appropriate and comprehensive documentation practices to ensure accurate capture of codes to protect revenue.Conduct training sessions on coding updates, and best practices for revenue optimization to individual providers or groups.Reporting and Communication
Prepare detailed audit reports, including findings, recommendations, and action plans using Microsoft products.Communicate audit outcomes to leadership, providing insights on improvement opportunities and risks.Act as a liaison between coding, compliance, and revenue cycle teams.Miscellaneous
Maintain confidentiality and comply with all HIPAA and / or regulatory and compliance requirements.Complete any other assignment, project, or priority as directed by Director / Team Lead.Research, analyzes, and responds to inquiries from both internal and external customers.Knowledge of payers in NJ, NY, PA, and FL.Non-Essential Functions :
Other duties, as assigned.Qualifications :
Associate or bachelor's degree required.Coding Certification of at least one of the following is required (two preferred) from AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders) such as CCS, CCS-P, CPC, CPMA, CDIP, RHIT, RHIA (other organizations and certifications will be considered).5 years of professional coding experience preferred.2 years of auditing experience preferred.Proficient with ICD-10 and CPT, E / M, HCPCS coding systems.Proficient in Microsoft Office Suite software.Knowledge of auditing concepts and principles.Experience developing and delivering provider education (face-to-face or web-based).Advanced knowledge of medical coding and billing systems and regulatory requirements.Ability to use independent judgment and to manage and impart confidential information.Ability to analyze and solve problems.Strong communication and interpersonal skills.Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.Knowledge of current and developing issues and trends in medical coding procedures requirements.Ability to clearly communicate medical information to professional practitioners and / or the public.Detailed knowledge of medical coding systems, procedures, and documentation requirements.Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.Ability to provide guidance and training to professional and technical staff in areas of expertise.Preferred : Proficiency with athenaOne.Preferred : Proficiency with audit software.Physical Requirements :
Mainly sedentary.Sitting at the desk most of the day.Standing or walking less than two hours per day.Lifting no more than ten pounds on rare occasions.Must be able to work at a computer and answer phone calls on a regular basis.Featured Benefits :
Health, dental, and vision insurance.401K with automatic employer contribution.PTO and Paid Holidays.Company paid Life Insurance.Access to voluntary short and long-term disability insurance.Access to additional life insurance.Access to a variety of Wellness programs.CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as "protected characteristics").
We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.
The Salary range for this position is
31 / hr. - $39 / hr.
Compensation is based on the level and requirements of the role.
Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.
Salary : $31 - $39
