Clinical Documentation Auditor (25% travel required CA Based) - Behavioral Health 901

"They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live..." - Client from Telecare

Join Our Compassionate Team

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

***This role will be required to travel to various Telecare clinical locations (up to 25%)***

**MUST RESIDE IN CALIFORNIA**

Full Time; Shift Hours and Days vary as needed

Expected starting wage range is $83,685.70 - $103,382.28. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

POSITION SUMMARY

The Clinical Billing Coding Auditor provides comprehensive and accurate coding and documentation auditing for the organization to identify revenue opportunities, prevent fraudulent payments, and ensure compliance with industry regulations.

The subject matter expert related to coding/billing functions within assigned settings of care, maintaining compliance with national coding policies and procedures, assisting with billing/coding questions and related topics, and assisting with auditing. Conduct analyses to evaluate the accuracy and efficiency of coding practices. Contribute to the development and updating of codes for patient billing.

QUALIFICATIONS

Required:

* Associate degree in a related field

* Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification

* American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P) or American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) certification.

* Five (5) years' experience auditing billing/coding

* Three (3) years' experience inpatient or outpatient billing / coding

* Must be willing to travel as needed.

* Must be at least 18 years of age.

* All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. Position requires driving, valid driver license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual or local requirements may apply

Preferred:

* Bachelor's degree in a related field

* Experience in health care operations

* Experience in project management

* CHC - certified in healthcare compliance, risk adjustment certification, or other compliance certifications.

ESSENTIAL FUNCTIONS

* Demonstrate the Telecare mission, purpose, values and beliefs in everyday language and contact with the internal and external stakeholders

* Maintains current knowledge of coding law and regulations, including AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding.

* Conducts prospective and retrospective chart reviews (i.e., baseline, routine periodic, monitoring, and focused) comparing medical and clinical documentation and notes that will be reported through CPT, HCPCS, and/or ICD-CM 10.

* Identifies coding discrepancies and formulates suggestions for improvement.

* Communicate audit results/findings to providers and clinicians and share improvement ideas.

* Work with the Chief Medical Officer and physician services leadership to identify and assist providers and clinicians with coding issues and questions.

* Report findings and recommendations to Corporate Compliance Officer, Quality and Sr. Management.

* Provide continuing education to providers and clinical staff on CPT, HCPCS, and ICD-10 CM coding.

* Support compliance policies with government (Medicare/Medi-Cal) and payer regulations

* Work closely with all departments, including but not limited to, Quality, Clinical Services, Nursing, Leadership, Finance, Information Technology, Training, and Revenue Cycle to assist in accuracy of reported services, as requested.

* Assist Quality Department on identifying key review indicators that could have a potential impact on the documentation of medical necessity through the ongoing review process.

* Advise ongoing updates of government coding and billing guidelines and regulatory updates. (CalAIM, ShareCare)

* Manage and conduct coding audits to evaluate completeness of record documentation in support of claim billing and reimbursement.

* May travel to programs as needed to support auditing, training and process improvement.

* Identifies potential underpayments or missed revenue due to process.

* Reports audit findings and collaborates on corrective actions.

* Collaborates on training and training development to overcome deficiencies.

Duties and responsibilities may be added, deleted and/or changed at the discretion of management.

Position requires driving own personal vehicle for company business such as trainings, offsite meetings, etc.

SKILLS

* Proficiency in correct application of CPT, HCPCS, ICD10-CM diagnosis codes used for coding and billing for all inpatient/outpatient claims.

* Excellent verbal, written, and communication skills.

* Excellent organizational skills, time management skills, and attention to detail.

* Ability to provide data and summarize with narrative and recommend process improvements.

* Intermediate to advanced skills in Microsoft Office Suite

* Knowledge and application with service billing requirements for California, specific to behavioral health and substance use services

* Knowledge of medical terminology and disease processes

* Critical thinking, problem solving and ability to multitask.

PHYSICAL DEMANDS

The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The employee is constantly required to sit and have repetitious hand movement; is occasionally required to stand, walk, bend, reach, and twist. They may occasionally lift and carry items weighing 10 pounds or less as well as do simple grasping. The position requires manual deviation and to occasionally drive. Visual requirements include computers and books exposure.

EOE AA M/F/V/Disability

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.