Under general supervision, reviews and audits medical records to ensure that the documentation contained in the medical records justifies the data billed on the encounters. Using established methodology, determines omissions and measures timeliness of encounter submissions. Develop and perform ongoing compliance training throughout the organization, including the development of staff training. Provide ongoing advice and resources to management for compliance issues and process monitoring and improvement, and work with management to implement these improvements. Assist Leadership with the development and implementation of the annual Compliance Work plans.
Training and experience equivalent to a bachelor’s degree and three (3) years’ experience auditing and/or monitoring healthcare records. Minimum of two years’ experience in claims processing required. ICD10, CPT, HCPCS and UB04 coding experience required. Coding experience or ability to demonstrate coding audit standard required. Must have a valid Claims Coding Certification from the American Academy of Professional Coders. Experience in quality management in the behavioral health field preferred. Must have a valid Arizona driver’s license and reliable transportation.
Office Location: Tucson, AZ
CPI is an equal opportunity employer. CPI does not discriminate based on age, ethnicity, race, sex, gender, religion, national origin, creed, tribal affiliation, ancestry, gender identity, sexual orientation, marital status, genetic information, veteran status, socio-economic status, claims experience, medical history, physical or intellectual disability, ability to pay, source of payment, mental illness, and/or cultural and linguistic needs, as well as any other class protected by law.