Coding & Documentation Compliance Specialist (CPC/CPMA)
据悉，在医疗保险等领域，我们正在帮助数千名患者获得 GLP-1治疗和全面的体重管理。包括医疗保險。我们的护理模式是纵向性，包括 MDs/DOs,NPs,PAs 和 RDNs. 我们会收费服务，同时也参与 MIPS. 你将是确保我们记录的内容支持我们的账单，并且我们正在捕获所有合法收入。这是一个实践编码和审计角色向高级医疗主管报告不是政策，票据办公室或一般合规地位。你将在两个模式下工作。未来，你将帮助我们评估哪些代码可以安全使用给定的访问类型以及需要哪些文件才能使用该技术符合要求。后期，你将审计图表以确认文档保持高精度，并转化改进的机会为模板，工作流修复和教育。你将做什么审核 · 在每次会议中进行基准文档审计 （1020个图表每个发票提供商）,并发布一个结果报告，供应商和服务线均有错误率 ·运行持续季度审计 （10个图表）加上专注于服务线审查。·在新代码推出期间执行100%的预账单检查，直到错误率低于5% ·在针对性教育的月度评估中放置任何供应商超过10%的错误率，直到他们回到门评价值。· 评估未使用或未充分使用的代码是否适合我们的护理模式，并定义我们在支付费用之前所需的文件。· 为我们的临床人员和支付费用的团队编写说明书。MIPS ·帮助成功地与 MIPS 合作，包括确定适当措施，确保我们的文档超越要求。·提供建议来提高我们的模板以优化准确性和符合 MIPS 要求；CPC (AAPC) 或 CCS-P (AHIMA) · CPMA 强烈偏好，或者相当的示范图审计经验；5年以上编程 o
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This is a remote position.
Remote (US-based) · Independent contractor · ~15–20 hrs/week ongoing · Reports to the Senior Medical Director
About Shapely
Shapely is transforming the weight loss industry through an innovative physician-led approach that makes weight loss care affordable for everyone. With evidence-based care, industry-leading support, and a seamless integrated app, we help thousands of patients across California, Florida, New York, and Texas access GLP-1 therapies and comprehensive weight management, all covered by insurance, including Medicare. Most of our patients are over 65.
Our care model is longitudinal and includes MDs/DOs, NPs, PAs, and RDNs. We bill fee-for-service and also participate in MIPS.
The role
You'll be the person who makes sure what we document supports what we bill, and that we're capturing everything we legitimately earn. This is a hands-on coding and auditing role reporting to the Senior Medical Director — not a policy, billing-clerk, or general compliance position.
You'll work in two modes. Prospectively, you'll help us assess which codes are safe to use for a given visit type as well as what documentation needs to be present to use teh coe compliantly. Retrospectively, you'll audit charts to confirm the documentation holds up with high accuracy, and turn opportunities for improvement into templates, workflow fixes, and education.
What you'll do
Audit
- Conduct a baseline documentation audit (10–20 charts per billing provider) across encounters, and deliver a findings report with error rates by provider and service line
- Run ongoing quarterly audits (10 charts per provider) plus focused service-line reviews.
- Perform 100% pre-bill review during new-code rollouts until the error rate is under 5%
- Place any provider above a 10% error rate on monthly review with targeted education until they're back under threshold
Code evaluation
- Evaluate appropriateness of unused or underused codes for our care model and define the documentation each requires before we bill it
- Write documentation guidance for our clinical staff and billing team.
MIPS
- Assist with success with MIPS, including determining appropriate measures and ensuring our documentation exceeds requirements.
- Provide suggestions on enhancing our templates to optimize accuracy and compliance with MIPS
Requirements
Required
- CPC (AAPC) or CCS-P (AHIMA)
- CPMA strongly preferred, or equivalent demonstrated chart-audit experience
- 5+ years coding outpatient E/M, with direct auditing experience
- Strong knowledge of Medicare telehealth rules
- Experience with MIPS reporting and quality-measure documentation
- US-based, with strong Medicare experience
Nice to have
- Obesity medicine, endocrinology, or primary care background
- Prior work with OIG self-disclosure or payer audit response
- Experience building documentation templates or clinician cheat-sheets
Originally posted on Himalayas