Position Description:

The Outpatient Coding Auditor is a member of the CGI Healthcare Compliance Audit Team. The primary responsibility of this role is to render appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments (overpayments and underpayments) on claims paid to various providers of clinical services, including outpatient hospital, ambulatory surgical centers, and physician offices, as well as other provider types and care settings. Ongoing training and education are provided specific to the audit processes, industry changes, and other topics as needed. In addition to coding and reimbursement expertise, this remote position requires a self-motivated, organized, detail-oriented person, with superior critical thinking and communication skills that is able to work independently and engage with other audit team members.

Your future duties and responsibilities:

• Reviews medical records to identify recovery opportunities on claims for outpatient facility, professional, and other allied health services.
• Provides a detailed rationale, including supporting references, for every review resulting in an outpatient findings letter.
• Correctly interprets and utilizes reference materials, including coding standards and guidelines, CPT Assistant, Coding Clinic for HCPCS, NCDs, LCDs, as well as client reimbursement and medical policies.
• Provides ongoing feedback to the Edit Development team on claims selection criteria and new recovery concepts.
• If the contract requires onsite review, interacts with Providers and other personnel in a professional manner.
• Follows CGI policies and procedures and completes Red Carpet, timesheets, payroll, travel expense documents, and other corporate requirements in a timely manner.
• Communicates timely with Team Lead regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.

Required qualifications to be successful in this role:

• The Outpatient Coding Auditor possesses current AHIMA or AAPC credentials (RHIT, RHIA, CCS-P, CPC, CPC-H/COC), along with robust critical thinking and problem-solving skills.
• The auditor demonstrates extensive knowledge of ICD-10-CM, CPT and HCPCS coding guidelines including appropriate use of modifiers, with a minimum of five years of outpatient surgical coding experience in the facility and/or professional setting.
• Experience coding specialty surgical areas including orthopedics, cardiology, spine and back, and/or interventional radiology is highly desired.
• The Outpatient Coding Auditor must have a moderate understanding of CMS’s Outpatient Perspective Payment System (OPPS) including APCs, NCCI, and OCE edits.
• Previous experience training and mentoring junior-level coders, and/or peer-review auditing is highly desired, as is familiarity with Charge Description Master (CDM).
• A solid working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, and Excel) and Windows operating systems is required in order to manage applications utilized in the CGI audit process.
• The auditor should have experience working with an encoder, preferably Trucode and be accustomed to reviewing medical records remotely.
• The ability to write a well-reasoned review in a narrative style, with correct spelling, grammar, punctuation, and sentence structure is required for success in this position.
• The auditor must be able to adapt to changing priorities in order to meet Client requirements, and is required to meet department quality and productivity standards.
• The auditor may be required to travel for additional training and on-site reviews on an as-needed basis.

*CGI is required by law in some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this range includes various factors not limited to: skill set level; experience and training; and licensure and certifications. CGI typically does not hire individuals at or near the top of the range for their role. Compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,300 -$118,700.

At CGI we call our professionals “Partners” to reinforce that all who join our team are, as owners, empowered to participate in the challenges and rewards that come from building a world-class company. CGIs benefits include:

CGI’s benefits are offered to eligible professionals on their first day of employment to include:
• Competitive compensation
• Comprehensive insurance options
• Matching contributions through the 401(k) plan and the share purchase plan
• Paid time off for vacation, holidays, and sick time
• Paid parental leave
• Learning opportunities and tuition assistance
• Member assistance and wellness programs

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Skills:

• Compliance
• Detail-oriented

What you can expect from us:

Together, as owners, let’s turn meaningful insights into action.

Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you’ll reach your full potential because…

You are invited to be an owner from day 1 as we work together to bring our Dream to life. That’s why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company’s strategy and direction.

Your work creates value. You’ll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.

You’ll shape your career by joining a company built to grow and last. You’ll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.

Come join our team—one of the largest IT and business consulting services firms in the world.

Qualified applicants will receive consideration for employment without regard to their race, ethnicity, ancestry, color, sex, religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual orientation or perceived sexual orientation, gender, gender identity, and gender expression, familial status, political affiliation, genetic information, height, weight, or any other legally protected status or characteristics.

CGI provides reasonable accommodations to qualified individuals with disabilities. If you need an accommodation to apply for a job in the U.S., please email the CGI U.S. Employment Compliance mailbox at US_Employment_Compliance@cgi.com. You will need to reference the Position ID of the position in which you are interested. Your message will be routed to the appropriate recruiter who will assist you. Please note, this email address is only to be used for those individuals who need an accommodation to apply for a job. Emails for any other reason or those that do not include a Position ID will not be returned.

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All CGI offers of employment in the U.S. are contingent upon the ability to successfully complete a background investigation. Background investigation components can vary dependent upon specific assignment and/or level of US government security clearance held. Dependent upon role and/or federal government security clearance requirements, and in accordance with applicable laws, some background investigations may include a credit check. CGI will consider for employment qualified applicants with arrests and conviction records in accordance with all local regulations and ordinances.

CGI will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with CGI’s legal duty to furnish information.