At TREND Health Partners, a tech-enabled payment integrity company, our mission is to facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. We achieve this by aligning the common goals of payers and providers and fostering collaboration through a shared technology platform and seamless workflows.Joining TREND Health Partners means becoming a part of a dynamic growing organization that promotes a collaborative and innovative work environment. Our comprehensive compensation package includes competitive salaries, highly valued health insurance, a 401(k) plan with employer match, paid parental leave, and more.The Outpatient Coding Auditor’s responsibility is to review medical records, clinical documentation, and claims to ensure accurate ICD-10, CPT, and HCPCs coding and compliance with CMS and coding guidelines. The role will be to apply coding principles based on industry standards and company/ client needs.Role and ResponsibilitiesValidate CPT, HCPCs and ICD-10 coding accuracy of outpatient claimsApply MUE/ NCCIReview medical documentation to support billed services/ itemsProvide appeal responses for claims of the above types utilizing industry standards and company/client policies.Assist with new concept development.Assist with claim selection criteria.Maintain certifications and continuing education requirements.May require client communication to support findings.QualificationsCoding certification in good standing. Examples: CCS, CPC, COC, RHIT, RHIAStrong knowledge of CPT, HCPCs and ICD-10 codingStrong knowledge of CMS and coding guidelinesKnowledge of outpatient coding and payment methodologies (APC, OPPS)Ability to review complex medical documentation.Coding validation/auditing experienceWell-developed verbal and written communication skillsAbility to effectively prioritize tasks.Microsoft Office experience, specifically Excel Preferred SkillsAppeals experience a plus.Clinical experience a plusClient communication experience a plusConcept development experience a plusClaim selection experience a plus.Experience with machine learning/artificial intelligence a plusClinical Documentation Improvement experience a plusRegistered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Registered Nurse (RN) a plusEncoder, Codify, TruCode/TruBridge, 3M, WebStrat or similar experience a plus Mental and Physical DemandsThis position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.The nature of the work is sedentary, and the employee will be sitting most of the time.Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.Related Duties As AssignedThis job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information.Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
