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Clinical Medical Coding Auditor
Location: Remote, Missouri
Work Setting: Consultant/Vendor
Job Function: Coding – Auditor
Job Type: Full-Time
Lumeris serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes. Lumeris enables clients to profitably achieve greater results through proven playbooks based on collaboration, transparent data and innovative engagement methodologies. Lumeris offers comprehensive services for managing all types of populations, including launching new Medicare Advantage Health Plans, Commercial and Government Health Plan Optimization, and Multi-Payer, Multi-Population Health Services Organizations (PHSOs). Currently, Lumeris is engaged with health systems, provider alliances and payers representing tens of millions of lives moving to value-based care.
Over the past seven years, we have tripled in size to more than 800 employees and built the only solution on the market with our proven outcomes. For the past six years, Essence Healthcare, a long-standing Lumeris client, has received 4.5 Stars or higher from the Centers for Medicare and Medicaid Services (CMS). Essence Healthcare was Lumeris’ pioneer client and has been leveraging Lumeris for more than a decade to operate its Medicare Advantage plans, which serve more than 60,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois.
In 2018, Lumeris was named Best in KLAS for Value-Based Care Managed Services in the area of client-reported impact on the Triple Aim by KLAS Research. This was the third year in a row Lumeris received the award, and it has only been given for three years. As the industry’s most reliable and effective partner for developing population health management solutions, our success is driving tremendous growth in our company. Join us today in making a real difference in how healthcare is delivered!
The selected candidate will be a key player in the continuing development of Lumeris Risk Solutions outreach to new and established clients. The incumbent will be instrumental in forging relationships to support the philosophy of complete and accurate coding and documentation to assure Medicare compliance and optimal data generation. Candidates will conduct outreach activities such as review of provider queries, one on one provider coding education and documentation guidance. The position will also support existing auditing functions by assisting in the development of appropriate provider queries and will support the education staff in assisting with the delivery of coding-focused education to providers and health plans as may be required. Candidates will assist designated Lumeris teams in working with provider populations to close Gaps in Care and other defined program goals.
Role and Responsibilities:
Reviews clinical documentation and coding during patient encounters in either a prospective or retrospective review to determine opportunities to improve provider documentation
Communicates identified opportunities to respective providers
Conducts timely follow-up reviews to ensure appropriate clinical documentation is recorded and resultant ICD-10 codes are assigned consistent with the Official Guidelines for Coding and Reporting (OGCR)
Participates in assuring provider coding and documentation compliance with Federal and State regulatory bodies
Educates members of the patient care team, including medical staff, on documentation guidelines on an on-going basis
Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with providers, care management and nursing staff, other care givers and the coding staff
Collaborates with coding staff to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance
Submits verbal, electronic or written queries as necessary to providers to ensure documentation of complete and accurate records to assure coding assignments accurately reflecting all relevant conditions of the patient population as defined in the OGCR
Reviews data and trends to identify additional areas of opportunity and to close gaps identified via data generated by Analytics
Delivers provider-specific metrics and coach providers on Gap-closing opportunities as needed
Maintains knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record
Experience, Qualifications and Education:
Ability to travel approx.50% annually
Completion of an AHIMA-approved ICD-10-CM training course; may substitute current AHIMA-approved ICD-10-CM trainer status
CDIP or CCDS credential AND a relevant coding credential (CPC, CPC-H, CPC-P, CCS, CCS-P)
Clinical background with relevant licensure / credentials in a current state
At least 3 years of experience in clinical documentation improvement, Coding and Documentation auditing, or in a provider setting with educational responsibilities to providers and related staff
Bachelor’s Degree (or higher / equivalent) and 3 years of experience as a concurrent or retrospective documentation specialist
RN, BSN, MD, DO, NP, PA or medical scribe with 2+ years of experience in documentation and coding
CRC (Certified Risk Coder) credential
Prior consulting experience
Lumeris is an EEO/AA employer M/F/V/D.
Posted: April 15, 2019 at 10:55 AM
Post ID: 38662