Auditor Med Records & Training - 52817

Auditor Med Records & Training - 52817

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

Anthem Blue Cross and Blue Shield is a proud member of the WellPoint family of companies. At Anthem we are dedicated to improving the lives of the people we serve and the health of our communities.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Location: Worthington, OH (near Columbus)

The Medical Records Audit & Training Consultant evaluates and audits physician and hospital medical records and medical assessment forms to ensure compliance with CMS guidelines and medical documentation requirements. This position is also responsible for serving as final auditing arbiter regarding the Sr. Risk & Recovery's Retrospective Risk Adjustment (RA) Coding Team and responsible for the identification of training opportunities for our internal and external stakeholders related to CMS guidelines, HCC best practices and medical record documentation requirements. Primary duties may include, but are not limited to: Collection and analysis of data to formulate recommendations and solutions based on audit trends and results, and develops and the development and delivery of training related to coding and medical documentation requirements. Provides regular feedback to Sr. Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps. Acts as a subject matter expert to internal and external stakeholders in the area of CMS requirements and HCC best practices. Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education. Assists the business with research and documentation of workflows and policies and procedures.



Requirements:

Requires a Bachelor's degree in health sciences, health management, nursing; or any combination of education and experience, which would provide an equivalent background. CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute). Candidates licensed as RN, LPN or PA and at least 5 years coding audit experience will be considered without CPC - however they must attain this CPC accreditation during their first year of employment. Additional certification (e.g. CPMA - Medical Auditing Certification or equivalent certification from accredited source) desirable. Five+ years experience relevant ICD-9 coding or medical record audit experience in a consultative role. Experience can be in a physician's office, hospital or insurance office setting. Experience developing educational materials and delivering training's related to ICD-9 coding.

WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2011 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at EOE