Remote Audit Manager Jobs in Applegate, CA (NOW HIRING)

Education and Work Experience:

• Bachelor's Degree or equivalent combination of education/experience: Required
• Master's Degree: Preferred
• Five years' related experience: Preferred
• One year's leadership experience: Preferred

Licenses/Certifications:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS): Required

Essential Functions:

• Oversees and monitors the coding program. Develops and coordinates educational and training programs regarding elements of the coding program such as compliance, appropriate documentation and accurate coding to all appropriate staff including coding staff, providers, billing staff and ancillary departments. Ensures the appropriate dissemination and communication of regulatory policy and guideline changes.
• Conducts and oversees coding audit efforts and coordinates monitoring of coding accuracy and documentation adequacy. Reports noncompliance issues detected through auditing and monitoring, the nature of corrective action plans and the results of follow-up audits to the HIM Director and the Compliance officer.
• Interacts with a variety of people who impact the success of the coding program and functions as a facilitator, liaison and/or motivator. Evaluates the impact of innovations and changes in programs, policies and procedures for the coding team. Designs and implements systems and methods to improve data accessibility. Identifies, assesses and resolves problems. Prepares administrative reports.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plan to prevent similar denials and rejections from recurring.
• Conducts trend analyses to identify patterns and variations in coding practices and case-mix-index. Monitors key coding performance indicators such as discharged, not final coded (DNFC), discharged, not final billed (DNFB), days in coding and others as identified by leadership.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.