Provider Consultant at USPI

Pawleys Island, South Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Jun, 26

Salary

0.0

Posted On

12 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Compliance Audits, E&M Reviews, ICD-10-CM, CPT Coding, HIPAA, Communication, Critical Thinking, Organizational Skills, EHR Experience, Intelicode, MD Audit, Teams

Industry

Description

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

Responsibilities

The role involves performing compliance audits based on CMS, CPT, ICD-10 guidelines, and state/federal regulations, focusing on Evaluation and Management (E&M) reviews. Responsibilities include documenting findings, writing recommendation worksheets, and presenting educational feedback to clients during summation calls.