Job Purpose The Coding Auditor will be responsible for inpatient and outpatient coding and auditing for various specialties. This role will also be responsible for preparing and presenting audit results.
Duties and Responsibilities
- Perform coding audits and compliance audits for providers, including physicians and mid-level providers. Prepare reports of audits and present audits to internal and external parties as needed
- Complete accurate application of appropriate coding and documentation guidelines, including but not limited to, E&M and surgery documentation guidelines, CCI guidelines, CPT/HCPCS coding guidelines, and specialty association guidance
- Provide physician education when necessary. This could include, but is not limited to, audit findings or edit and denial trending.
- Complete coding audits for our copartners’ coding WQ
- Work with any offsite auditors
- Evaluate and report on the overall quality of physician documentation that supports selected codes most specifically but not inclusive of medical necessity
- Adhere to local and national coverage determinations, and CCI and payer specific editing rules
- Ensure appropriate documentation and coding of split/shared services, teaching physician guidelines and any client specific quality assessment programs
- Compile, trend, analyze and report on all findings that do not meet all of the guidelines listed above
- Maintain a professional attitude
- Other duties as assigned by the management team
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
- High School diploma or equivalent required
- CPC or CCS coding certification required from AHIMA or AAPC
- Minimum 5 years of coding experience and minimum 2 years auditing experience in a multi-specialty setting
- Must be able to use job-related software
- Self-starter with ability to work independently
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills, ability to communicate well at all levels of the organization
- Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
Working Conditions
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.
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