Coding Compliance Auditor

Imagine Pediatrics

Imagine Pediatrics

Posted on Friday, May 17, 2024

Who We Are

We are Imagine Pediatrics, a devoted and compassionate, multi-disciplinary pediatrician-led medical group that is creating a world where every child with complex medical conditions gets the care and support they deserve. Energized by our mission to reimagine pediatric health care, we are pioneering virtual-first care services that include care coordination and around-the-clock access to complex-care clinicians from home. We don’t replace a child's existing care team. Instead, we collaborate to deliver continuous support to kids, so they can spend less time in the hospital and more time thriving at home and in their communities.

Every day we boldly challenge old approaches and seek out new and better ways to improve the health and lives of children with medical complexity. In partnership with caregivers, providers, and health plans, we break down the barriers that stand between families and quality care for their children. We know we can’t solve every challenge in the lives of these kids, but we can work tirelessly to give them, their families, and other caregivers the help and relief they need, right when they need it. We know a better approach to pediatric health care is within reach, and we are committed to seizing it today.

What We Live By

We’re guided by our five core values:

  • Children first. We put the best interests of children above all. We are uncompromising in our commitment to improving the lives of children and families by bringing the best care to them.
  • Earn trust. We cherish the trusting relationships we build with the children and families we serve, our partners, and each other. We seek first to understand and speak honestly.
  • Innovate today. We refuse to accept the way things have always been done. Children and families are waiting for our help and their bravery demands that we relentlessly challenge assumptions to develop new approaches.
  • Embrace humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to learn and grow stronger.
  • One team, diverse perspectives. We work alongside families as one team towards a shared purpose. We champion diversity and acknowledge the contributions of others.

What You’ll Do

The Coding Compliance Auditor will partner cross functionally with medical and coding staff to ensure accurate and timely coding for a first-of-its- kind pediatric risk bearing provider. This highly visible role will be instrumental in standing up a scalable auditing function following appropriate coding practices and regulatory guidelines in a remote-first, high-growth company environment to ensure all coding activities are handled in accordance with national coding guidelines and Imagine Pediatrics’ coding policies.

  • Review pediatric-based Medicaid records and documentation to ensure accurate and complete coding in accordance with official coding guidelines as set forth by CMS regulations, and other applicable federal and/or state guidelines (e.g., AHIMA, ACOG, CMS, Medicaid); and health plan-specific policies.
  • Build, implement, and maintain auditing processes which will include building standardized workflows to educate providers, partnering with data and technology teams to construct automated reporting dashboards, and working with coding managers to ensure iterative improvement on key metrics over time.
  • Collaborate and consult with internal clinical leadership on chart assessments to address coding discrepancies to maintain operational excellence and ensure continual delivery of high-quality care
  • Review audit findings with physicians and coding staff. Educate and recommended ways to improve as needed.
  • Perform follow-up audits to ensure remediation of findings and report the status of remediation efforts.
  • Prepare written reports of findings to the Chief Compliance Officer on charts reviewed per week, coding accuracy, and progress towards implementing and following guidelines
  • Provide guidance regarding need for external vendors and partnerships

What You Bring & How You Qualify
First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support they deserve.

  • 3-5+ years of medical coding and auditing experience preferably in a high-growth environment
  • Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
  • Prior experience coding or auditing in a Medicaid environment
  • Experience providing training and education to staff and clinicians using excellent verbal and written communication skills
  • Thorough understanding of HEDIS measures and E&M coding
  • Bachelor’s degree in healthcare management or related field preferred
  • Familiarity with EMR software (e.g., Athenahealth)
  • CPC or CRC; and CPMA required
  • Excellent organizational, project and program management skills; experience leading change and implementing programs.
  • Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences.

We Value Diversity, Equity, Inclusion and Belonging

We believe that creating a world where every child with complex medical conditions gets the care and support they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.