Outpatient Audit Specialist
Overview:
Datavant is a data platform company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.
By joining Datavant today, you’re stepping onto a highly collaborative, remote-first team that is passionate about creating transformative change in healthcare. We invest in our people and believe in hiring for high-potential and humble individuals who can rapidly grow their responsibilities as the company scales.Datavant is a distributed, remote-first team, and we empower Datavanters to shape their working environment in a way that suits their needs.
As an Outpatient Auditing Specialist, you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews.In this role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!
Responsibilities:
What you will do:
- Performs Outpatient Facility encounter reviews of medical records and abstracts using ICD-10-CM, CPT, HCPCS, and modifiers and appropriate coding references for accurate coding assignment
- Reviews all CPT and HCPCS codes impacting APC assignment
- Provides coder education via the auditing process
- Prepares preliminary results for review by the facility
- Reviews coding recommendation disagreements with appropriate manager
- Prepares the final reports for the coding audit. Participates in settlement of audit findings
- Provides coder education via email and/or conference call using the audit spreadsheet findings and comments
- Attends coding workshops as necessary
- Keeps abreast of regulatory changes
- Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution
- Shows versatility and exemplary work including a wide range of services coded
- Meets with client facility representatives to discuss issues and trends identified in audit
- Develops and implements education for physician, nursing, and other clinical staff to improve documentation
- Develops and implements education for coding staff to improve coding procedures
- Demonstrate initiative and judgment in performance of job responsibilities
- Communicates with co-workers, management, and hospital staff regarding clinical and reimbursement issues
- Function in a professional, efficient and positive manner
- Adhere to the American Health Information Management Association (AHIMA)’s code of ethics
- Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
- Audits external coding encounters as needed and provides reports to manager as directed
- High complexity of work function and decision making
- Strong organizational, teamwork, and leadership skills
Qualifications:
What you will bring to the table:
- Required: 5+ years of outpatient facility coding and/or auditing experience
- Required: RHIA, RHIT, and/or CCS credentials.
- Preferred: Recent academic medical center or level I trauma center auditing experience.
Perks:
- Full Benefits including a 401k Savings Plan
- Access to 20-24 free CEUs per year, provided by Datavant
- Compensation for AAPC/AHIMA dues
- Company-provided equipment including computer, monitor, mouse, etc.
- Comprehensive training led by a credentialed professional coding manager
We are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.
Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks (competitive San Francisco rates for US-based roles) and industry best practices.
We’re building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. This means we default to simple job titles (e.g., Software Engineer) rather than complex ones (e.g., Senior Software Engineer). The range posted is for a given job title, which can include multiple levels.Individual rates for the same job title may differ based on level, responsibilities, skills, and experience for a specific job. The estimated pay range for this role is $40.00- $45.00 per hour.
At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your responses will be anonymous and used to help us identify areas of improvement in our recruitment process. (We can only see aggregate responses, not individual responses.In fact, we aren’t even able to see if you’ve responded or not.) Responding is your choice and it will not be used in any way in our hiring process.
This job is not eligible for employment sponsorship.
Equal Pay Act Minimum Range: $40.00 - $45.00 per hour