Outpatient Auditor - SMART Reviewer
Pittsburgh, PA
Full-time
Remote
1 month ago
About the role
Description
About e4health
At E4health, Our Vision Is To Empower Better Health For Our Clients, Our Team, And The Communities We Serve. We Live By Five Core Values That Guide Everything We Do
Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at www.e4.health.
Position Title
Outpatient Auditor
Role Type
Full Time - x2 roles open
Employment Type
Non-Exempt
Job Summary
The Outpatient Auditor is responsible for completing quality assurance reviews on internal and/or external outpatient coding specialists or external providers. The facility-based chart types may include one or more of the following: Emergency Department, Observation, Same Day Surgery, Ancillary, Interventional Radiology, or Facility-Based Clinic. This may also include onboarding audits and training of newly hired e4health coding specialists. This role is responsible for validating the coding specialist is accurately for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, and CMS directives. The Outpatient Auditor also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding specialist, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Outpatient Auditor is expected to maintain consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.
Essential Duties And Responsibilities
Benefits
We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy.
Physical Demands Of The Essential Functions
This role requires prolonged periods of desk working on a computer
Talking, hearing, and near vision are required to perform computer-based tasks and virtual communication
Sensory perception (visual, auditory, and tactile) is essential for computer and phone use
Working Conditions While Performing Essential Functions
This is a remote role; work is performed in a home office environment.
e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.
Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position .
Requirements
REQUIRED QUALIFICATIONS:
Key Success Attributes
Integrity, passion, and ethics are required
Demonstrates strong collaboration skills
Has strong analytic and problem-solving abilities and techniques
Exhibit consistent initiative with strong drive for results and success
Demonstrate commitment to a team environment?
Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
Ability to self-motivate and self-direct
Possess strong time management and organizational skills
Commitment and adherence to company Core Values
Core Competencies
High level of integrity & ethical judgement
Communication
Consistency and Reliability
Meeting Standards
About e4health
At E4health, Our Vision Is To Empower Better Health For Our Clients, Our Team, And The Communities We Serve. We Live By Five Core Values That Guide Everything We Do
- Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth.
- Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day.
- WE GROW: We believe in win/win outcomes—when our customers win, we win.
- GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions.
- Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully.
Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. Our solutions streamline clinical, financial, and health information workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at www.e4.health.
Position Title
Outpatient Auditor
Role Type
Full Time - x2 roles open
Employment Type
Non-Exempt
Job Summary
The Outpatient Auditor is responsible for completing quality assurance reviews on internal and/or external outpatient coding specialists or external providers. The facility-based chart types may include one or more of the following: Emergency Department, Observation, Same Day Surgery, Ancillary, Interventional Radiology, or Facility-Based Clinic. This may also include onboarding audits and training of newly hired e4health coding specialists. This role is responsible for validating the coding specialist is accurately for accurately abstracting data into appropriate client electronic medical record systems, following the Official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, and CMS directives. The Outpatient Auditor also plays a key role in reporting quality results, tracking and trending of educational opportunities of the coding specialist, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Outpatient Auditor is expected to maintain consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.
Essential Duties And Responsibilities
- Complete all regularly scheduled quality assurance reviews for clients
- Complete onboarding quality assurance reviews for newly hired consultants
- May provide training for newly hired coding consultants
- Communicate quality issues to management as appropriate
- Assist with identification of, drafting, implementation, and monitoring of quality improvement action plans for coding consultants
- Maintain reports and accuracy rates for coding consultants and clients as appropriate.
- Respond to client QA needs at the direction of management
- Provide coding consultants educational sessions on error trends as requested by management
- Notifying management when there is a compliance concern or incident
- Demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information
- Promoting confidentiality and using discretion when handling patient information.
- Attend educational conference calls
- Provide coding support to the business as needed
- Perform other duties as needed with the project
- Maintains required productivity and quality requirements
- Maintains coding credential requirements
Benefits
We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy.
Physical Demands Of The Essential Functions
This role requires prolonged periods of desk working on a computer
Talking, hearing, and near vision are required to perform computer-based tasks and virtual communication
Sensory perception (visual, auditory, and tactile) is essential for computer and phone use
Working Conditions While Performing Essential Functions
This is a remote role; work is performed in a home office environment.
e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.
Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position .
Requirements
REQUIRED QUALIFICATIONS:
- Candidate must possess an approved AHIMA or AAPC coding credential; CIRCC/RCCIR a plus
- Minimum 4 years’ coding experience required; specialty experience may be preferred as per specific client needs
- Minimum 2 years of auditing experience preferred
- Recommend at least 2 years of remote experience
Key Success Attributes
Integrity, passion, and ethics are required
Demonstrates strong collaboration skills
Has strong analytic and problem-solving abilities and techniques
Exhibit consistent initiative with strong drive for results and success
Demonstrate commitment to a team environment?
Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
Ability to self-motivate and self-direct
Possess strong time management and organizational skills
Commitment and adherence to company Core Values
Core Competencies
High level of integrity & ethical judgement
Communication
Consistency and Reliability
Meeting Standards
Skills
Hospitals and Health Care