Provider Consultant

Location

United States

Posted

87 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Provider Consultant

HiACode

Overview: Performs compliance audits based on current CMS, CPT, ICD-10 guidelines, as well as all state and federal regulations. Utilizes the CMS 95/97 or 2021 documentation guidelines for evaluation and management (E&M) reviews. Writes and presents concise recommendation worksheets with appropriate findings and references to clients during summation calls. Writes Executive Summaries and must communicate with different levels within the practice/facility. Utilizes review databases (Intelicode, MD Audit, etc). Required Skills and Experience: • High School diploma with at least one AAPC credential; CPC preferred • Minimum 5 years review experience in a multispecialty clinic/facility • ICD-10-CM training • Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources • Experience using Electronic Health Record (EHR) • Independent, focused individual able to work remotely. • Sound organizational, communication and critical thinking skills Responsibilities: - Prepares for Review - Reviews Evaluation and Management codes based on CMS 95/97 or 2021 Documentation Guidelines - Reviews records assigned to ensure appropriate diagnosis reporting based on ICD-10-CM Guidelines (addition, deletion, revision, re-sequence) - Reviews records assigned to ensure appropriate CPT reporting based on CPT coding conventions. - Reviews record for documentation opportunities and compliance issues based on Federal and State guidelines and/or Payor requirements. - List out findings with recommendations from guidelines/regulations (CMS Documentation Guidelines, Coding Clinic, Federal Regulations, CMS Physician Services Guidelines, etc.) to provider client with educational feedback for corrective action. - Research State/Federal and/or Payor guidelines to support recommendations made - Uses various software applications, groupers, encoders and other coding tools to analyze and ensure appropriate codes, sequencing and edits - Runs preliminary and final reports as required - Completes client rebuttals and makes appropriate changes in database as needed - Prepares for Summation Conference using Teams - Conducts Summation Conference with Administration - Conducts Summation Conference with staff and or providers as requested Client Relations: • Maintains adequate communication with client throughout the review process to ensure review goals and objectives are met • Leads organized summation conference in an approachable, educational manner for client staff • Provides ongoing educational support to client staff between scheduled reviews by researching issues and responding promptly to client inquiries Performance and Professionalism • Maintains strict confidentiality and adheres to HIPAA guidelines • Exhibits professional demeanor at all times • Maintains communication by responding promptly to Corporate office staff • Demonstrates flexibility, open mindedness, and versatility in adjusting to changing environments • Handles constructive feedback with a positive attitude • Receptive to suggestions for changing or improving the way work is accomplished • Commits to continually improving his/her job skills (i.e. attends educational meetings

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