Job Details

ProFee Audit Specialist

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. As a ProFee Audit Specialist you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. In this role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!

For this position, we are seeking an auditor with a broad range of experience across multiple specialties, with strong expertise in neurosurgery and orthopedics. Experience in Interventional Radiology and HCC is a plus.

You Will:

• Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG and APC assignment.
• Review non-CC/MCC records to assess proper coding or identify the need for additional documentation. Scrutinizes all HCPCS and CPT codes influencing APC assignment.
• Provide coder education through the auditing process.
• Prepare preliminary results for review by the facility or CCS HIM director.
• Review disagreements on APC/DRG changes with the appropriate manager.
• Prepare the final reports for the coding audit and actively participates in the resolution of audit findings.
• Provide coder education via email and/or conference calls, utilizing the audit spreadsheet findings and comments.
• Attend coding workshops as necessary.
• Stay current with regulatory changes.
• Organize and prioritize multiple cases concurrently to ensure departmental workflow and prompt case resolution.
• Demonstrate versatility and exceptional work across a wide range of coded services.
• Meet with client facility representatives to discuss issues and trends identified in audits.
• Develop and implement education for physicians, nursing, and other clinical staff to enhance documentation.
• Communicate effectively with co-workers, management, and hospital staff regarding clinical and reimbursement issues.
• Function in a professional, efficient, and positive manner.
• Adhere to the American Health Information Management Association's code of ethics.
• Maintain a customer-service focus and exhibits professionalism, flexibility, dependability, a desire to learn, commitment to excellence, and commitment to the profession.
• Conduct audits on external coding staff as needed and provides reports to the manager as directed.
• Handle a high complexity of work functions and decision-making.
• Demonstrate strong organizational, teamwork, and leadership skills.

What You Will Bring To The Table:

3-5 years experience auditing

Associate or Bachelor's degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCS

Preferred: CCS, RHIT, or RHIA credentials.

Recent experience in academic/level 1 trauma centers

Experience coding and auditing inpatient and outpatient records for various facilities

Track record of acceptable productivity standards

Maintain 95% accuracy rate for APC assignment and 95% productivity rate

Experience with various software including EMR, Encoder and Auditing software

Perks:

Benefits for Full-Time employees: Medical, Dental, Vision, 401k Savings Plan w/match, 2 weeks of paid time off, and Paid Holidays, Floating Holidays

Free CEUs every year

Stipend provided to assist with education and professional dues (AHIMA/AAPC) If Applicable

Equipment: monitor, laptop, mouse, headset, and keyboard

Comprehensive training led by a credentialed professional coding manager

Exceptional service-style management and mentorship (we're in this together!)

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated base pay range per hour for this role is: $35$45 USD

To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.

Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.