Navigant Consulting Inc Medical Coding Auditor - Outpatient- Health Systems Solutions - Remote Location in MITCHELL, South Dakota

Health System Solutions (HSS) is a newly formed Joint Venture between Navigant Consulting, Inc. and Baptist Health South Florida (BHSF). Health System Solutions will provide revenue cycle management services initially to BHSF and then expand to other providers. This new company combines Baptist Health South Florida’s highly skilled staff and Navigant’s industry-leading RCM expertise, innovative processes and technology tools.

The combination of Navigant’s strong market position in outsourced revenue cycle management and Baptist Health South Florida, as an internationally renowned center of excellence for healthcare services, creates an exceptionally strong company to compete in the ever-changing healthcare services industry. Health Systems Solutions will help healthcare services providers defend, protect, and create value in the midst of transformational change or when facing significant regulatory or legal pressures.

  • Serve as an expert in Outpatient Prospective Payment System

  • Maintain coded data quality through ongoing quality review and assessment of outpatient records

  • Perform con-current audits on accuracy of APC, ASC or MSDRGs as well as on quality of medical record documentation needed for accurate coding

  • Prepare reports, identifies trends and takes appropriate actions in response

  • Work with HIM coding management in developing education and training for coders, clinical department and/or physicians for documentation improvement

  • Create consistency and efficiency in outpatient claims processing and data collection to optimize APC, ASC or DRG reimbursement and facilitate data quality in hospital outpatient services ensuring regulatory compliance

  • Monitor daily audits of coded outpatient medical records to validate principal and secondary diagnosis, procedure, DRG or APC, medical necessity in accordance with regulatory coding guidelines with 98% accuracy rate

  • Monitors daily audits of abstracted data quality (i.e.: discharge disposition, surgeon, POA, etc) reported to the state and federal agencies for local and national data comparisons in accordance with regulatory guidelines with 98% accuracy rate

  • Audit according to productivity performance standards and goals set by department

  • Assess training and education needs and assists management with the development and delivery to improve quality of coding to coders, CDI, physicians or clinical departments

  • Manage ongoing audits resulting from external denials (RAC, FMQAI and other recovery company) and appeals when necessary

  • Prepare monthly reports providing information on all audit results as well as recommendations to management

  • Assist management with training new coders or contract coders to include daily monitoring, feedback and education

  • Maintain CEUs and updates coding knowledge through readings of articles/newsletters and attending seminars/meetings

  • Complete annual assigned AHIMA CATS modules

  • Work in conjunction with AR Manager to ensure appropriate training is provided to gain required knowledge and be successful as a coding specialist

  • High School diploma

  • Certified Coding Specialist (CCS)

  • Minimum 2 years of experience

  • Preferred Bachelor’s Degree in Health Information Management or equivalent

  • Preferred AHIMA approved ICD10CM/PCS Trainer

  • Proficient in ICD9CM/PCS, ICD10CM/PCS, CPT4, and HCPCS coding conventions and guidelines, encoder and National and Local Coverage Determinations

  • Proficient in Word, Excel and PowerPoint

  • Communicate frequently with co-workers as well as with managers to discern their needs, and be able to express themselves

  • Work as a member of a team as well as be a self-motivator with ability to work independently

  • Constantly operates a computer and other office equipment to coordinate work

  • Usually remains stationary for the majority of the day

  • Frequently communicates with clients and coworkers and must be able to share information effectively

  • Generally works in an office environment

Health System Solutions is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Health System Solutions will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.