Coding Auditor/Educator

The Menninger Clinic•Houston, TX

1d•Hybrid

About The Position

The Coding Auditor/Educator will be responsible for medical record auditing, provider education and credentialing, maintaining knowledge of information and functionality, and assisting with other accounting projects. This role involves ensuring accurate ICD-10 and CPT coding, interpreting clinical documentation, and educating clinical staff on coding guidelines. The position also requires staying current with regulatory requirements and improving processes for claims processing and collections.

Requirements

Completion of an accredited medical coding/billing program.
2 years of experience in medical/psychiatric billing and collections.
Proficient in CPT and ICD10 coding.
Understanding of behavioral health language/terminology.

Nice To Haves

Associate’s degree in Business or related field.
Knowledge of Cerner EMR.

Responsibilities

Performs initial charge review to determine appropriate ICD-10 and CPT codes are being used.
Interprets medical evaluations, consults, progress notes, and other clinical documentation to determine services provided are assigned accurate coding.
Reviews all physician documentation to ensure compliance with third-party and regulatory guidelines.
Monitors and follows up to ensure all services that can be billed are captured and coded for billing.
Identifies and resolves clinical documentation and charge capture discrepancies to improve the quality of clinical documentation, severity and reimbursement levels assigned, and integrity of charges data reported.
Remains current with regulatory requirements and new contracts with third-party payers.
Recommends changes to Menninger guidelines as needed.
Educates new clinical staff on the correct usage of CPT coding guidelines, including contractual variances with third-party payors.
Conducts ongoing training sessions as CPT guidelines continue to change.
Assures compliance with all health plan requirements as related to provider certification and credentialing.
Reviews and streamlines processes and workflows for the onboarding department, using automation where appropriate.
Observes all HIPAA required practices, including maintaining HIPAA compliance and confidentiality for all patient and clinic information.
Maintains knowledge of computer system functions as it pertains to Patient Accounts.
Uses data and information to assist in decision-making.
Makes recommendations to improve the processing of claims, collections of accounts, and statements to clients.
Assists with other Accounting projects as assigned and completes other duties as requested.
Accepts additional assignments willingly.
Demonstrates an ability to respond to changing workloads.
Prepares in a timely and accurate manner all other tasks as assigned.