Gainwell Technologies
Inpatient Coding Auditor, Senior Associate- Remote
Gainwell Technologies, Indiana, Pennsylvania, us, 15705
Overview
We are seeking a talented individual for an Inpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines, specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems. Gainwell operates with a sense of urgency and offers flexibility in hours, a focus on work-life balance, continuous learning, and career development.
What You Will Do
Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Uses advanced ICD-10 coding expertise to substantiate conclusions. Documents audit determinations and rationale using HMS proprietary auditing systems.
Consistently achieves productivity and quality performance standards established by management.
Cross-trains to review multiple claim types to provide a flexible workforce to meet client needs.
Assists management with training new Coding Auditors, including daily monitoring, mentoring, feedback and education.
Maintains current knowledge of coding guidelines and completes required CEUs to maintain coding certification.
Attends training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
What We Are Looking For
1+ years of active professional credentials through AHIMA or AAPC: CPC, CCS, COC, RHIA, RHIT; required
3+ years coding inpatient or outpatient claims; required
Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology
Demonstrates a thorough understanding of APR-DRG, AP-DRG, and MS-DRG
Demonstrated experience in medical record coding and auditing
Proficiency in computer skills and typing (Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers) and virtual meeting tools (Microsoft Teams, Zoom, etc.)
What You Should Expect In This Role
Remote (work from home) environment
Benefits on first day of employment
Clear path for advancement with training and leadership
The pay range for this position is $55,000.00 - $75,000.00 per year. Base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. You will have the opportunity to grow your career in a company that values work flexibility, learning, and career development. Salaried, full-time employees are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. The company also offers leadership and technical development academies to build skills and capabilities.
Gainwell Technologies is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics.
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We are seeking a talented individual for an Inpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in either facility-based inpatient coding and/or outpatient coding edits and has a high level of understanding in reimbursement guidelines, specifically an understanding of the MS-DRG, AP-DRG and APR-DRG, ASC and APC payment systems. Gainwell operates with a sense of urgency and offers flexibility in hours, a focus on work-life balance, continuous learning, and career development.
What You Will Do
Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Uses advanced ICD-10 coding expertise to substantiate conclusions. Documents audit determinations and rationale using HMS proprietary auditing systems.
Consistently achieves productivity and quality performance standards established by management.
Cross-trains to review multiple claim types to provide a flexible workforce to meet client needs.
Assists management with training new Coding Auditors, including daily monitoring, mentoring, feedback and education.
Maintains current knowledge of coding guidelines and completes required CEUs to maintain coding certification.
Attends training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
What We Are Looking For
1+ years of active professional credentials through AHIMA or AAPC: CPC, CCS, COC, RHIA, RHIT; required
3+ years coding inpatient or outpatient claims; required
Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology
Demonstrates a thorough understanding of APR-DRG, AP-DRG, and MS-DRG
Demonstrated experience in medical record coding and auditing
Proficiency in computer skills and typing (Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers) and virtual meeting tools (Microsoft Teams, Zoom, etc.)
What You Should Expect In This Role
Remote (work from home) environment
Benefits on first day of employment
Clear path for advancement with training and leadership
The pay range for this position is $55,000.00 - $75,000.00 per year. Base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. You will have the opportunity to grow your career in a company that values work flexibility, learning, and career development. Salaried, full-time employees are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. The company also offers leadership and technical development academies to build skills and capabilities.
Gainwell Technologies is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics.
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