Employment Type

: Full-Time


: Accounting

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Job Description
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: Yes
Work Schedule: Days

With minimal supervision directly supports the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS; compliance to all external regulatory agency coding rules and regulations; Demonstrates high-level of proficiency in performing and/or managing on-site internal audits or reviews to assess compliance/quality monitoring performed by PHS/PMG departments while serving as a resource on documentation, coding, billing, and coding compliance questions. Works on special coding compliance related projects, develops and presents educational programs, disseminates information to PHS/PMG departments and develops educational tools used to maintain compliance with regulations. Provides support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; perform medical record and billing reviews of denied and appealed claims and takes appropriate action to ensure accurate payment of claims; coordinate review and tracking of appealed claims including the communication process with affected payers; research and interpret all regulatory agency regulations


*Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments in addressing functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management.esponsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form

*Must be able to adapt to frequently changing work priorities and schedules. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes

*Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Identifies risks, develops and follows up on action plans, identifies lost revenue opportunities and any overpayments due to errors in coding and/or documentation, and provides compliance education

*Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments

*Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. Keeps actively informed on the business climate of the healthcare industry

*Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management

*Maintains up-to-date working knowledge of all PHS coding and auditing IT applications

*Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group

*Conducts training classes in areas of coding, documentation and compliance for PHS/PMG personnel. This includes preparation of training materials, educational audits and answering specific situational questions, ICD-10 education and EPIC EMR documentation education to providers and clinical staff

*Conducts systematic focused internal audits via medical record and charge ticket review to insure correct coding, billing and charging as member of CDQA audit team

*Analyzes and summarizes data from medical record and account audits and communicate results and findings to management and complianceDevelops new methods and processes to improve coding efficiency and effectiveness

*Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care. Ensures that coding functions are performed in accordance with established quality and performance standards by monitoring system generated reports and quality audits

*Working hours may vary based on projects assigned

*Must be able to travel to all of the PHS/PMG sites (including overnight). Travel varies at certain times based on assignments

High school diploma/GED required. Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS and a minimum of three (3) years experience in coding and/or auditing required. Audit experience preferred. Excellent written and verbal communication skills. . Excellent written and verbal communication skills. Detail and results oriented. Ability to work independently and make independent decisions. Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.

Must have a proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for service lines(s) assigned.

Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously.

Must possess computer skills, especially with Microsoft Word, PowerPoint, and Excel applications. Must be able to use the internet and other resource applications for research purposes and to provide documentation that supports regulations quoted in audits.

Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in laymans terms.

Must possess a personal presence of a highly qualified professional that is characterized by a sense of honesty, integrity, and the ability to inspire and motivate others.

* High School Diploma or GED

* Certified Professional Coder

The Professional requires a CPC, CCS-P and/or CPMA

Competencies and skills:
* SKILL-Ability to effectively interact with customers to understand their needs and explain data
* SKILL-Microsoft Office
* Planning and coordinating organizational change
* Anticipating & Addressing Customer Needs
* Educating Employees, Customers & Transferring Knowledge
* Functioning as an Effective Contingent Member
* Diagnosing & Resolving Problems
* Acquiring & Applying Superior Skills to achieve Quality Outcomes
* Functioning as an Effective Team Member
* SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
* SKILL-Written communicatio n


Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries
  • Full medical, dental and vision insurance
  • Flexible spending accounts (FSAs)
  • Free wellness programs
  • Paid time off (PTO)
  • Retirement plans, including matching employer contributions
  • Continuing education and career development opportunities
  • Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.



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