Health Information Associates

  • Physician Services Consultant

    Job Locations US-Remote Office
    ID
    2015-1014
    Category
    HIApro
  • Overview

    Performs compliance audits based on current CMS, CPT, ICD-10 guidelines, as well as all state and federal regulations. Utilizes the CMS 1995 or 1997 documentation guidelines for evaluation and management (E&M) reviews. Writes and presents concise recommendation worksheets with appropriate findings and references to clients during summation calls. Writes Executive Summaries and must communicate with different levels within the practice/facility. Utilizes HIAcompliance or other review databases (Intelicode, MD Audit, etc) when requested by the client. Requires some travel.

    Responsibilities

    • Prepares for Review
    • Reviews Evaluation and Management codes based on CMS 1995 or 1997 Documentation Guidelines
    • Reviews records assigned to ensure appropriate diagnosis reporting based on ICD-10-CM Guidelines (addition, deletion, revision, re-sequence)
    • Reviews records assigned to ensure appropriate CPT reporting based on CPT coding conventions. Including but not limited to:
      • Surgeries of all specialties from OR/outpatient to minor office procedures
      • Psychiatric services
      • Chemo therapy
      • Radiology
      • Laboratory
      • Anesthesia
      • Pathology
      • Critical Care
      • Pain Management
      • Palliative Care
    • Reviews record for documentation opportunities and compliance issues based on Federal and State guidelines and/or Payor requirements. Including but not limited to:
      • Verifying Incident To and split/shared visit guidelines are met
      • Scribe services
      • Teaching physician requirements
      • Cloning of records
      • Legibility for hand written notes
      • Unapproved abbreviations
      • Signature requirements
      • Correct place of service reported
      • Correct date of service reported
    • List out findings with recommendations from guidelines/regulations (CMS Documentation Guidelines, Coding Clinic, Federal Regulations, CMS Physician Services Guidelines, etc.) to provider client with educational feedback for corrective action.
    • Research State/Federal and/or Payor guidelines to support recommendations made
    • Uses various software applications, groupers, encoders and other coding tools to analyze and ensure appropriate codes, sequencing and edits
    • Runs preliminary and final reports as required
    • Completes client rebuttals and makes appropriate changes in HIAcompliance as needed
    • Prepares for Summation Conference using WebEX
    • Conducts Summation Conference with Administration
    • Conducts Summation Conference with staff and or providers as requested

     

     

    Qualifications

    • College Degree with appropriate AHIMA, AAPC and/or HCCA credentials.
    • Minimum 5 years review experience in a multispecialty clinic/facility.
    • ICD-10-CM/PCS training
    • Computer proficiency, able to research coding questions and utilize HIA’s internal educational resources
    • Experience using Electronic Health Record (EHR)
    • High Speed Internet via Cable (no Satellite or wireless cell based)
    • Independent, focused individual able to work remotely.
    • Sound organizational, communication and critical thinking skills

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