Outpatient Coding Auditor - Remote

Outpatient Coding Auditor - Remote

Position Description
The Outpatient Coding Auditor is a member of the CGI Healthcare Compliance Audit Team. The primary responsibility of this role is to render appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments (overpayments and underpayments) on claims paid to various providers of clinical services, including outpatient hospital, ambulatory surgical centers, and physician offices, as well as other provider types and care settings. Ongoing training and education are provided specific to the audit processes, industry changes, and other topics as needed. In addition to coding and reimbursement expertise, this remote position requires a self-motivated, organized, detail-oriented person, with superior critical thinking and communication skills that is able to work independently and engage with other audit team members.

• This position can be located remotely anywhere in the U.S, and candidates must be willing to work in Eastern Time Zone hours.

Your future duties and responsibilities
• Reviews medical records to identify recovery opportunities on claims for outpatient facility, professional, and other allied health services.
• Provides a detailed rationale, including supporting references, for every review resulting in an outpatient findings letter.
• Correctly interprets and utilizes reference materials, including coding standards and guidelines, CPT Assistant, Coding Clinic for HCPCS, NCDs, LCDs, as well as client reimbursement and medical policies.
• Provides ongoing feedback to the Edit Development team on claims selection criteria and new recovery concepts.
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
• Follows CGI policies and procedures and completes Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.

Required qualifications to be successful in this role
• The Outpatient Coding Auditor possesses current AHIMA or AAPC credentials (RHIT, RHIA, CCS-P, CPC, CPC-H/COC), along with robust critical thinking and problem-solving skills.
• The auditor demonstrates extensive knowledge of ICD-10-CM, CPT and HCPCS coding guidelines including appropriate use of modifiers, with a minimum of five years of outpatient surgical coding experience in the facility and/or professional setting.
• Experience coding specialty surgical areas including orthopedics, cardiology, spine and back, and/or interventional radiology is highly desired.
• The Outpatient Coding Auditor must have a moderate understanding of CMS's Outpatient Perspective Payment System (OPPS) including APCs, NCCI, and OCE edits.
• Previous experience training and mentoring junior-level coders, and/or peer-review auditing is highly desired, as is familiarity with Charge Description Master (CDM).
• A solid working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, and Excel) and Windows operating systems is required in order to manage applications utilized in the CGI audit process.
• The auditor should have experience working with an encoder, preferably Trucode and be accustomed to reviewing medical records remotely.
• The ability to write a well-reasoned review in a narrative style, with correct spelling, grammar, punctuation, and sentence structure is required for success in this position.
• The auditor must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department quality and productivity standards.
• The auditor may be required to travel for additional training and on-site reviews on an as-needed basis.

CGI anticipates accepting applications for this position through November 30, 2024.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

*CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to: skill set level; experience and training; and licensure and certifications. CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,300 -$118,700.

At CGI we call our professionals "CGI Partners" to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGI's benefits include:

CGI's benefits are offered to eligible professionals on their first day of employment to include:

• Competitive compensation including profit participation program
• Comprehensive medical, dental, and vision benefits
• Basic life and accidental death & dismemberment insurance
• Matching contributions through 401(k) plan, and CGI share purchase plan
• Flexibility and paid accrued vacation leave, ranging from 10 to 20 days per year, based on job level, years of relevant prior experience, and years of service
• 10 paid holidays per year
• At least 80 consecutive hours of paid sick/safe leave (except where applicable state/local law requires more)
• Paid parental leave, ranging from 20 to 70 consecutive business days based on circumstances of leave and applicable laws
• Bereavement leave, ranging from 1 to 7 days per year based on relationship.
• Paid jury duty leave, up to time summoned
• Learning opportunities and tuition assistance
• Wellness and Well-being programs

For more detailed information about our benefits offerings visit Benefits | CGI Careers

Please note that the benefits listed above are subject to change based on the specific terms and conditions of the contract being supported.

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Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at [email protected]. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.

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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI's legal duty to furnish information.