CPMA Educator, Auditor

Job not on LinkedIn

🔥 8 minutes ago

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

💵 $57.2k - $97.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

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Presbyterian Healthcare Services

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1908

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Presbyterian Healthcare Services is an integrated, nonprofit healthcare system based in New Mexico that operates hospitals, urgent care clinics, specialty and primary care practices, virtual care (VirtualPRES), and health insurance plans. The organization provides a broad range of clinical services—including neuroscience, transplant, cancer care, surgery, behavioral health, and home health—while also running community health and charitable programs (financial assistance, community support, and partnerships with medical education). It offers individual, Medicaid, Medicare Advantage, and employer health plans, plus patient tools (MyChart/myPRES), billing support, and commitment to access and quality across the state.

📋 Description

• Support implementation and compliance with enterprise-wide and department coding policies and procedures • Ensure compliance with external regulatory agency coding rules and regulations • Perform and/or manage on-site internal audits and quality reviews • Serve as a resource for documentation, coding, billing, and coding compliance questions • Work on special coding compliance-related projects • Develop and present educational programs and tools • Audit and train enterprise-wide corrective action plans for low-performing coding, audit, physician, and clinician personnel • Review denied and appealed claims and take appropriate action to ensure accurate payment • Coordinate review and tracking of appealed claims and communicate with affected payers • Research and interpret regulatory agency regulations • Liaise with Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance, and ancillary departments • Maintain and disseminate current legal and regulatory information, including ICD-9, ICD-10, CPT-4, HCPCS, and APC updates • Research coding, billing, and charging compliance issues and implement corrective action plans • Identify risks, lost revenue opportunities, and overpayments due to coding or documentation errors • Assist in creating the CDQA Annual Audit Work-plan • Respond to daily coding and auditing inquiries and ad-hoc analysis requests • Maintain working knowledge of PHS coding and auditing IT applications • Gather and analyze information and recommend solutions for business issues • Conduct coding, documentation, and compliance training classes, including ICD-10 and EPIC EMR documentation education • Conduct focused internal audits through medical record and charge ticket review • Analyze and communicate medical record and account audit findings to management • Develop methods and processes to improve coding efficiency and effectiveness • Research and investigate patient care and billing concerns • Monitor reports and quality audits to ensure coding functions meet quality and performance standards

🎯 Requirements

• High school diploma/GED required • Must possess at least one of: RHIT, RHIA, CPC, CCS • Minimum of three (3) years experience in coding and/or auditing required • Audit experience preferred • Excellent written and verbal communication skills • Detail and results oriented • Ability to work independently and make independent decisions • Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required • Proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations • Excellent organizational and planning skills • Ability to prioritize multiple tasks and perform them accurately and simultaneously • Computer skills, especially Microsoft Word, PowerPoint, and Excel • Ability to use the internet and other resource applications for research • Ability to communicate complex regulatory information in layman's terms • Must be able to travel to all PHS/PMG sites, including overnight • Must be able to work varying hours based on assigned projects

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Short-term disability • Long-term disability • Group term life insurance • Optional voluntary benefits • Employee Wellness rewards program • Gift cards and more through wellness activities • Wellness challenges • Webinars • Preventive screening • Full-time employment