Description

SunStone Consulting is seeking an individual with in-depth expertise with professional and outpatient facility documentation, coding and billing audits, within a workplace culture which emphasizes open communication and opportunities for growth. Must be highly organized and possess a nursing and/or other clinical degree, clinical expertise, and at least one coding certification. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.

Responsibilities:

• Assist management with the development of the Audit Approach for projects that aligns with the Scope of Services for the specific client engagement.
• Assist with and provide clinical oversight and coding support to consulting team during documentation, coding and billing reviews.
• Perform quality review of consultant’s findings and assists Senior Managers in the preparation of observations and recommendations for reporting purposes based on regulatory references and overarching claim review findings.
• Apply comprehensive knowledge of Medicare and Medicaid guidelines, Conditions of Participation, state healthcare regulations, and official coding guidelines for ICD-10-CM and CPT to compliance audits. Demonstrates expertise in utilizing regulatory coding resources such as AMA E/M guidelines, CPT Assistant, NCCI, and Coding Clinics.
• Assist with governmental or third-party payer denials by evaluating compliance with coding guidelines, LCD’s, NCD’s and any applicable CMS or managed care payer guidelines.
• Conduct research surrounding governmental or third-party payer guidelines by evaluating applicable coding guidelines, LCD’s, NCD’s and any applicable CMS or payer guidelines. Ability to articulate research findings in a cohesive, well written manner for ease of client interpretation.
• Prepare accurate and thorough work papers related to audit findings, with clinically credible documentation references to support findings.
• Develop education material and facilitates education with clients on clinical documentation and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.

Requirements

• Bachelor of Science Degree in Nursing (BSN) and/or Current licensure as a Registered Professional Nurse; BSN preferred (other clinical degrees can be considered).
• Certified Procedural Coder (CPC), Certified Outpatient Coding (COC), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
• Clinical experience as well as a minimum of 10+ years of multi-entity health information and/or clinical/coding experience.
• In-depth expertise with professional and outpatient facility documentation, coding and billing audits.
• Demonstrated proficiency in preparing accurate and thorough work papers related to audit findings, with clinically credible documentation references to support findings.
• Strong clinical background with knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of services and diagnoses.
• Ability to communicate and collaborate effectively with managers, clients and team members.
• Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.
• Proficient in Microsoft Office Suite including Word, Excel and e-mail applications.