Medical Auditor II, Revenue Cycle Management, Amazon One Medical
Amazon · Virtual, United States · Finance & Accounting
As a key member of the Amazon One Medical Revenue Cycle team, the Medical Auditor will be responsible for supporting Amazon One Medical Clinical and Revenue Cycle teams in managing and optimizing compliant healthcare revenue cycle operations. Demonstrating increased autonomy and strategic thinking and problem-solving skills, this role will perform detailed reviews of medical coding practices to ensure accuracy, compliance with regulatory requirements and adherence to organizational policies and procedures. This role reports into the Coding Compliance Auditing Manager, Revenue Cycle.
As someone who naturally enjoys finding ways to improve the status quo, you adeptly identify and create processes necessary to get work done. You comfortably interact with your team members as well as other teams and easily tailor your message and communication style to different audiences. You have a high accountability bar and know how to motivate others, consistently following through on commitments and ensuring others do the same.
Key job responsibilities
- Conduct regular audits to verify accuracy of ICD-10-CM, CPT, HCPCS, and modifier medical codes
- Review documentation to verify appropriate code assignment
- Ensure coding reflects clinical documentation and meets medical necessity requirements
- Identify coding inaccuracies and opportunities for improvement
- Track and report coding errors and findings
- Maintain detailed records of audit findings
- Ensure adherence to coding guidelines and regulatory requirements
- Follow established policies and procedures, and surfaces and escalates compliance concerns as appropriate
Basic Qualifications
- Experience using data to drive root cause elimination and process improvement- 3+ years of data analysis and formula creation in Microsoft Excel experience
- CPC certification through AAPC or CCS certification through AHIMA
- 3+ years of coding/auditing experience in the professional fee and/or risk adjustment setting working with Medicare, Medicare Advantage, and Commercial payers required
- Knowledge of industry standard code sets and associated guidelines (ICD-10-CM, CPT, HCPCS)
- Advanced knowledge and understanding of HCC Risk Adjustment, coding and documentation requirements
- CPC certification through AAPC and/or CCS certification through AHIMA
- Strong written and verbal communication with attention to detail
- Strong organizational, analytical, problem solving, and time management skills
Preferred Qualifications
- Experience with end-to-end project management- Experience prioritizing and handling multiple assignments at any given time while maintaining commitment to deadlines, or experience in a fast-paced, high-tech company
- Bachelor’s Degree in healthcare related field
- Demonstrated ability to identify and communicate trends in coding and documentation
Amazon is an equal opportunity employer and does not discriminate on the basis of protected veteran status, disability, or other legally protected status.
Los Angeles County applicants: Job duties for this position include: work safely and cooperatively with other employees, supervisors, and staff; adhere to standards of excellence despite stressful conditions; communicate effectively and respectfully with employees, supervisors, and staff to ensure exceptional customer service; and follow all federal, state, and local laws and Company policies. Criminal history may have a direct, adverse, and negative relationship with some of the material job duties of this position. These include the duties and responsibilities listed above, as well as the abilities to adhere to company policies, exercise sound judgment, effectively manage stress and work safely and respectfully with others, exhibit trustworthiness and professionalism, and safeguard business operations and the Company’s reputation. Pursuant to the Los Angeles County Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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The base salary range for this position is listed below. Your Amazon package will include sign-on payments and restricted stock units (RSUs). Final compensation will be determined based on factors including experience, qualifications, and location. Amazon also offers comprehensive benefits including health insurance (medical, dental, vision, prescription, Basic Life & AD&D insurance and option for Supplemental life plans, EAP, Mental Health Support, Medical Advice Line, Flexible Spending Accounts, Adoption and Surrogacy Reimbursement coverage), 401(k) matching, paid time off, and parental leave. Learn more about our benefits at https://amazon.jobs/en/benefits.
USA, , - 23.00 - 34.00 USD hourly