International Society on Thrombosis and Hemostasis
Auditor for Surgical Acute and Profee Coding - Remote
International Society on Thrombosis and Hemostasis, Houston, Texas, United States, 77246
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Caring. Connecting. Growing together. The Auditor for Acute & Profee Surgical will be a Subject Matter Expert in Surgical CPT coding. The Auditor will have responsibility for auditing and educating both providers and coders on surgical CPT coding for Middle Revenue Cycle Coding Services Operational Team with a focus on CPT, ICD-10-CM classification, Modifier assignment, and Official Coding Guidelines. This role will audit both acute and professional CPT code assignments. Auditor/Educator will provide key concepts for surgical CPT coding supporting providers and coders on current regulations, coding guidelines, and payer requirements. Primary Responsibilities:
Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations: Executes the integration of the Optum360 Coding functions and processes in the facilities they serve Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs, metrics and the overall client and/or patient experience Works collaboratively with HIM, CDI, and Coding Operations to monitor day to day coding operations, prebill coding reviews, and prebill quality reviews Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement. Leads initiatives towards meeting and exceeding employee satisfaction Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results Participates actively in leadership forums at the system level and leads such forums and other informational/educational offerings for assigned HIM/Coding/CDI Managers Provides team leadership and promotes a successful business operation by: Fosters teamwork atmosphere between business and clinical stakeholders Provides staff training and mentoring Provides development of employees through consistent and constructive feedback geared towards accuracy Rewards and recognizes performance and provides leadership direction during the common review process Seeks to innovate and foster innovative ideas toward the development of staff to ensure increased employee engagement and employee satisfaction Other duties as needed and assigned by Optum360 leadership, including but not limited to leading and conducting special projects. Develops project work plans, facilitates resource allocation, executes project tasks and obtains assistance from other intra and inter-departmental resources, as required Subject Matter Expert of applicable Federal, State, and local laws and regulations, Optum360's organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects Required Qualifications:
AAPC or AHIMA (CCS, CPC, RHIT or RHIA) coding credential 5+ years of recent OP coding and/or coding reviewer role experience Experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy Experience with computer assisted coding technologies and EMR (electronic medical records) coding workflow Proficiency with: Microsoft Excel, Word, PowerPoint, and SharePoint Driver's License and access to reliable transportation Preferred Qualifications:
Coding/auditor experience in cardiothoracic, neuro, opthalmic, oral, maxiofacial, spine, trauma, hematology, oncology, plastics and vascular Demonstrated operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations Proven excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects) Proven ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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Caring. Connecting. Growing together. The Auditor for Acute & Profee Surgical will be a Subject Matter Expert in Surgical CPT coding. The Auditor will have responsibility for auditing and educating both providers and coders on surgical CPT coding for Middle Revenue Cycle Coding Services Operational Team with a focus on CPT, ICD-10-CM classification, Modifier assignment, and Official Coding Guidelines. This role will audit both acute and professional CPT code assignments. Auditor/Educator will provide key concepts for surgical CPT coding supporting providers and coders on current regulations, coding guidelines, and payer requirements. Primary Responsibilities:
Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff and best demonstrated coding practices; drives the integration of Optum360 Coding related business objectives within the client environment Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations: Executes the integration of the Optum360 Coding functions and processes in the facilities they serve Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs, metrics and the overall client and/or patient experience Works collaboratively with HIM, CDI, and Coding Operations to monitor day to day coding operations, prebill coding reviews, and prebill quality reviews Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency Maintains expert knowledge of coding to ensure high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results including remediation, education, and when appropriate assisting to create and monitor corrective action plans Serves as the liaison between the coding operations collaboratively bring each unit together including establishing, building, and maintaining cohesive relationships with the client Effectively utilizes tools and data provided to capture and continually improve union, client, and employee engagement. Leads initiatives towards meeting and exceeding employee satisfaction Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment which achieves maximum results Participates actively in leadership forums at the system level and leads such forums and other informational/educational offerings for assigned HIM/Coding/CDI Managers Provides team leadership and promotes a successful business operation by: Fosters teamwork atmosphere between business and clinical stakeholders Provides staff training and mentoring Provides development of employees through consistent and constructive feedback geared towards accuracy Rewards and recognizes performance and provides leadership direction during the common review process Seeks to innovate and foster innovative ideas toward the development of staff to ensure increased employee engagement and employee satisfaction Other duties as needed and assigned by Optum360 leadership, including but not limited to leading and conducting special projects. Develops project work plans, facilitates resource allocation, executes project tasks and obtains assistance from other intra and inter-departmental resources, as required Subject Matter Expert of applicable Federal, State, and local laws and regulations, Optum360's organizational integrity program, standards of conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Promotes a service-oriented culture within the organization and assures satisfaction with the quality and amount of support provided for departmental functions, initiatives, and projects Required Qualifications:
AAPC or AHIMA (CCS, CPC, RHIT or RHIA) coding credential 5+ years of recent OP coding and/or coding reviewer role experience Experience working collaboratively with CDI and Quality leadership in partnership to improve reimbursement and coding accuracy Experience with computer assisted coding technologies and EMR (electronic medical records) coding workflow Proficiency with: Microsoft Excel, Word, PowerPoint, and SharePoint Driver's License and access to reliable transportation Preferred Qualifications:
Coding/auditor experience in cardiothoracic, neuro, opthalmic, oral, maxiofacial, spine, trauma, hematology, oncology, plastics and vascular Demonstrated operational knowledge of health care related Federal and State regulations, as well as standards from regulatory agencies and accrediting organizations Proven excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects) Proven ability to work with a variety of individuals in executive, managerial and staff level positions. The incumbent frequently interacts with staff at the Corporate/National, Regional and Local organizations. May also interact with external parties, such as financial auditors, third party payer auditors, consultants, and various hospital associations UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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