Supervisor, Outpatient Audit Operations
New
M
MachinifyHealthcare Intelligence
Remote - USFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 7+ years of facility outpatient coding experience
- Required Skills
- Microsoft Excel
Requirements
- Active certification: RHIA, RHIT, CCS, CPC, or COC.
- 7+ years of facility outpatient coding experience in a hospital or health system.
- 2+ years of outpatient facility coding audit, pre-payment/post-payment reimbursement review, or payment integrity experience.
- 3+ years of management or leadership experience, preferably overseeing remote coding audit staff.
- Comprehensive knowledge of CMS OPPS (APC grouping, status indicators, packaging).
- Working knowledge of APG methodology.
- Proficiency in CPT/HCPCS Level II coding and NCCI/OCE logic.
- Experience with electronic medical records (EHR) and coding/encoder tools.
- Strong analytical skills and proficiency with MS Office (Intermediate Excel).
- Ability to work independently in a remote setting.
Responsibilities
- Oversees and reviews audit determinations to ensure consistency in APC/APG grouping decisions, OPPS packaging interpretation, and outpatient coding policy application.
- Proactively identify potential backlogs and align resources to meet business needs and SLAs.
- Contributes to the development of medical review guidelines, coding education materials, and outpatient-specific training content.
- Accountable for achieving established productivity, quality, turnaround time, and employee engagement goals.
- Ensures audit activities are performed in accordance with regulatory requirements, client contracts, and organizational policies.
- Supervises daily activities of outpatient coding audit staff, providing guidance and constructive feedback.
- Supports management with strategy activities including capacity planning, staffing models, and cost/benefit analysis.
- Analyzes operational, productivity, and quality metrics; develops reports and dashboards for stakeholders.
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