Remote Risk Adjustment Auditor Jobs in Michigan (NOW HIRING)

At the direction of the Regional Managerand Supervisor, Coding, this positionis responsible forimplementation and ongoing activities of the coding quality and compliance planfor theassignedRegional Health Ministries (RHMs).

Performs coding quality reviews as outlined in the coding qualityplan;such as by coder, service line, focus area and as otherwise necessary to ensureaccuratecoding and DRG or APC assignment.Develops coder education based on results of coding quality reviews, audit results, and regulatory changes.Provides a high-level of technical competency and serves as a subject matter expertregardingdocumentation, coding, billing,reimbursementand compliance management as it relates to coding.Assistswith denials management, complex case resolution and may perform coding tasks as directed.

Coordinates and supports correction of errors occurring with coding systems.Provides coder support via phone or written communications, including in-services and other user group forums.Provides direction for daily coding assignments and operations.Responsible for developing andmaintainingcoding systems training and process documentation.Assistswith training andonboardingof new coding colleagues.

Workmay be onsite and/or remote.

ESSENTIAL FUNCTIONS

Knows, understands,incorporatesanddemonstratesthe Trinity Health (TH) mission,visionand values of Trinity Health in leadership behaviors,practicesand decisions.

Maintains current knowledge of the MS-DRG system, CCs/MCCs, impact onquality, risk of mortality, severity of illnessand CMI as well as ICD-10 coding systems and the guidelines related to Clinical Documentation Integrity.Maintains current knowledge of CPT/HCPCS coding systems and APCassignment.

Provides direction for daily coding assignments and workflow.

Develops andmaintainsan expertlevelworking knowledge of coding systems, policies, and processes, training courses,materialsand certification exercises.

Designs and develops training and education programs that align with end-user needs for components of coding systems and processes.

Coordinates provision of training programs and functions as the trainer/facilitator of coding training programs.Trains and on-boards new coding colleagues.

Provides user support through phone coverage, written updates and communications, userforumsand other available tools and methods.

Conducts auditing and monitoring of coding and abstracting completed by coders.Communicatesdiscrepancies in coding and abstracting to the Supervisor and Regional Manager.

Conducts coding quality reviews andreportsfindings to Supervisor and Regional Manager on a routine basis.

Assistswith denials, complex coding cases, claim edits and errors,and may perform coding duties as workflow necessitates.

Serves as the technical resource for coding systems support,testingand training.

Designs,developsand delivers effective educational programs, informational materials and workflow tools thatassiststheRegional Coding Leadership with integrating compliance into their operations and improving processes and skills.

Maintains professional development and growth byparticipatingasappropriate incontinuing educational programs and activities that pertain to healthcare and coding.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health Corporate Integrity Program, Code of Ethics, as well as other policies and proceduresin order toensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

Mustpossessadvancedknowledge ofmedical terminology, anatomy and physiology, disease process, anddiagnostic and procedural coding, as normally obtained through anAssociate's degree in Health InformationTechnology, or a related field, or an equivalent combination of years of education and experience in a complex healthcare environment.

At least five (5)years ofcurrenthospital-based coding experience is required.

Must becurrentlycertifiedasone of the following:

Certified Coding Specialist (CCS).

Registered Health Information Administrator (RHIA).

Registered Health Information Technician (RHIT).

Certified Outpatient Coder (COC).

Certified Professional Coder (CPC).

Analytical abilityand skill to effectively and efficiently resolve a broad range of coding issues.Critical thinking skillsand the ability to work independently with minimal supervision, organizeworkand set priorities.

Demonstrated experience withuseof coding classification systems such as ICD-10 and CPT/HCPCS.

Demonstrated, currentexpertisewith 3M HDM encoders, 3M reporting tools, 3M Computer Assisted Coding (CAC).Working knowledge of Epic EMR preferred.

Comprehensive knowledge of diagnostic and procedural codingprincipals, conventions, methodologies, and prospective payment systemsrespectiveto coding compliance requirements.

Demonstrated ability to interpret coding regulations,guidelinesand standards, such as Coding Clinic.

Knowledge of Medical Necessity review guidelines (LMRP/LCD and SI/IS criteria) for commercial, Medicare and Medicaid insurance products.Usesknowledge of insurance criteria and regulationsin order toexpediteappropriate useof resources and compliance with 3rdparty payer contracts.

Demonstrated knowledge of state and federal Hospital Acquired Conditions (HAC) and other applicable quality indicator codes (i.e.PSI, PPI, etc.).

Responds to customer inquiries courteously and timely.Facilitates the resolution of problematic situations related to coding.

Interpersonal skills necessary to effectively interact with the coding team, patients, medical staff, other health ministrydepartmentsand any outside agencies.

Intermediate computer skillsrequired, including working knowledge of and experience using MS Word, Excel,Outlookand PowerPoint. Must be able to spendmajorityof work time utilizing a computer, monitor and keyboard.

Strong understanding of the Catholic health ministry in an evolving health care delivery system and changing reimbursement market.

Personalpresence thatis characterized by a sense of honesty, integrity, and caring as well as the ability to inspire and to motivate others to promote the philosophy, mission, vision, goals, and values of the Ministry.

PHYSICALAND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Ability to work in a fast-paced, multi-customer environment, with conflicting needs. Maywarrantvaried and/or extended hours, with changes in workload and priorities to keep pace with the industry and advanced strategic priorities.

Mustpossessthe ability tocomply withenterprise policies and procedures.

Must be able to spendmajorityof work time utilizing a computer, monitor and keyboard.

Mustpossessa valid driver's license and be able to travel toassignedTrinity Health sites as needed.

Hourly Pay Range: $32.52 - $48.76

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification.They are not to be construed as an exhaustive list of duties so assigned.