Clinical Documentation Auditor-CDI

Company Description

Telecare Corporation is a family- and employee-owned company that has been treating individuals with serious mental illness since 1965. We specialize in innovative, outcomes-driven services tailored for high-risk individuals with complex needs. With a commitment to improving mental health care, Telecare is dedicated to providing compassionate and excellence-driven services to make a lasting impact on our clients' lives.

Role Description

This is a full-time hybrid role for a Clinical Documentation Auditor-CDI- open to anyone residing within the California market that is open to travel to the CA based program locations with the flexibility of some work from home. The Clinical Documentation Auditor provides comprehensive oversight to ensure accurate clinical documentation, auditing and coding for the organization, identifying revenue opportunities, prevention of fraudulent payments, and adherence to local, state and federal compliance regulations.

As the subject matter expert identifies areas for improvement in clinical documentation practices, revenue coding/billing functions and compliance. Conduct analyses to evaluate the accuracy and efficiency of coding practices in all program settings and contributes to the development and updating of codes for client billing. The position collaborates with organizational stakeholders to enhance documentation and contribute to accurate coding and revenue reimbursement based on county specific billing requirements. They assist in the education of all staff in the best practices and regulatory requirements that impact on all clinical and revenue issues.

 Salary: 90k- 115k

QUALIFICATIONS

Required:

·     Experience inpatient/outpatient billing / coding in a behavioral health, co-occurring diagnoses and CalAim environment

·     Credentialed as a Registered Health Information Administrator (RHIA) through AHIMA

o  Six (6) years of experience in the management of behavioral health clinical records across all levels of care including, but not limited to: acute, subacute, inpatient, and skilled nursing and community programs or four (4) years of experience and Certified Documentation Integrity Practitioner /CDI

·     Registered Health Information Technician (RHIT) through AHIMA

o  Eight (8) years of experience in the management of behavioral health clinical records across all levels of care including, but not limited to: acute, subacute, inpatient, and skilled nursing and community programs or six (6) years of experience and Certified Documentation Integrity Practitioner/CDI

·     Certified Coding Specialist (CCS), Certified Coding Specialist – Physician based (CCS-P) or American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) certification

o  Five (5) years’ experience clinical auditing, billing, coding

·     Knowledge of Federal and State Regulatory and Accreditations Requirements (i.e., HIPAA, CMIA, LPS, 42 CFR Part 2. OBRA, 6Joint Commission, CARF) 

·     Working knowledge of external reporting requirements, where applicable i.e. HCAI, OSHPD, NRI, DHCS

·     Knowledge of various EHR and Hybrid Record Systems and Conversions 

·     Must be willing to travel 25%

·     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. If the 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

·     Experience in project management

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 in 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 collaborate 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

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