Medical Coding and Compliance Auditor --CPC

Concentra is recognized as the nation’s leading occupational health care company.
With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America’s workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees.

The Auditor, Coding & Compliance - Occupational Medicine and Specialty will perform detailed coding and documentation audits and reviews to ensure compliance with clinical and coding guidelines. This function is critical to the overall revenue cycle in supporting charge entry, level of service selection, procedure and diagnosis coding, as well as one on one, and group education and training to employed and contracted clinicians. The Auditor will provide in-depth, real-time feedback on appropriate documentation, charge capture and Level of Service code selection. A thorough knowledge of state specific worker's compensation coding and billing guidelines is required for this position. The audit findings are compiled and analyzed and then the results scheduled and presented to the clinical by the auditor, via telephone of video platforms in accordance with the clinician's schedule.

• Complete compliance audits for designated clinicians/centers consistent with established audit protocols and nationally recognized guidelines.
• Meet the production and QA standards as set out in Concentra Coding and Compliance policies.
• Analyze audit findings and identify/assess potential compliance risks related to coding and billing and notify clinical leadership regarding outliers.
• Organize and present the audit findings to each clinician as indicated by either the audit results, denial and down coding trends, and/or as requested by medical leadership, center leadership or Central Billing Office leadership
• Schedule meetings to present audit findings and be available to meet with clinicians via Zoom as their schedules dictate, accommodating calls outside of normal working hours when the need arises.
• Assist CBO's with reconsideration, appeals process and coding support as requested
• Participate in special projects and collaborate with other departments to support coding, auditing, and compliance initiatives.
• Provide clinician support, education and training related to the quality of documentation, level of service, procedure and diagnosis coding consistent with established coding guidelines and standards
• Collaborate with Medical Leadership in development of clinician training plans and for active support in the training process under guidance of coding leadership
• Monitor Coding and State Workers’ Compensation changes to ensure that most current information is available
• Ensure adherence to all State and Federal guidelines applicable to coding, billing and documentation compliance for Worker's Compensation in all served markets

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Education Level: High School Diploma or GED
Certifications and/or Licenses:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• Maintain a coding credential from AAPC or AHIMA organization.
• Must complete CEUs to maintain this credential bi-annually or as required by the organization
• Obtain and maintain membership to the AAPC or AHIMA organization
• Experience in lieu of required education is acceptable: Yes

Job-Related Experience

• Customarily has at least four (4) years of experience working as a certified Coder
• Prefer at least three (3) years in coding and compliance/clinical audit field
• Prefer experience in dealing directly with, and in presenting work product to clinicians

Job-Related Skills/Competencies

• Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
• Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
• Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
• The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
• Coding and auditing experience
• Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access and similar databases
• Working knowledge of routine and non-routine concepts, practices and procedures within billing and coding
• Strong understanding and application of Evaluation and Management Guidelines
• Excellent process and time management skills
• High degree of accuracy and attention to detail
• Organized and ability to analyze multiple sources of data
• Proficient written, oral communication
• Work independently and as part of a team
• Able to multi-task
• Ability to meet multiple deadlines
• Expertise in scheduling and facilitating Training and presentation skills (in person and virtual)
• Familiarity with state specific workers' compensation regulations
• Coding analytics experience