Coding Auditor Senior

Highmark Health • PA, Working at Home - Pennsylvania, PA

5d • $34 - $54

About The Position

The Senior Coding Auditor evaluates medical records to determine the accuracy of coding, billing, and documentation related to DRG, OPPS, and outpatient claims. This role involves reporting findings verbally and in writing, communicating results to affected areas, and using this information to generate topics for education, process changes, and risk reduction. The auditor provides guidance to System entities in response to external coding audits conducted by Medicare Administrative Contractors, RAC, MIC, ZPIC, etc. Additionally, the position interacts with external consultants regarding billing, coding, and/or documentation, and evaluates their recommendations and teaching plans in accordance with federal and state regulations and guidelines.

Requirements

• Bachelor’s Degree and Registered Health Information Administrator (RHIA) certification or ten (10) years’ experience in a medical record setting and one (1) of the following certifications from a certifying body must apply: American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA), AHIMA Credentials (Inpatient or Outpatient): Registered Health Information Technician (RHIT), Certified Coding Specialist(CCS), AAPC Credentials (Outpatient): Certified Professional Coder Hospital Outpatient (CPC-H), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA)
• Minimum of 7 years’ experience in hospital coding and auditing as well as experience in educational techniques and methods
• Must be proficient in Diagnosis Related Groups (DRGs), National Correct Coding Initiatives, ICD 10 Official Guidelines, Outpatient Prospective Payment System and Coding Clinic references
• Strong analytical and communication skills are required
• Knowledge of reimbursement systems and regulations pertaining to health information (HIPAA, CMS, etc.)
• Proficient writing skills, preparation of reports and training materials and presentation of clear and concise information (oral and written) are also required
• Ability to effectively communicate findings to staff as well as senior management and external regulatory agents
• Proficient in use of Microsoft Word, Excel and PowerPoint

Nice To Haves

• Master’s Degree.

Responsibilities

• Audits and reports on the documentation, coding and billing performed at System entities.
• Reviews, develops and delivers training programs and educational materials which address deficiencies identified in the audits.
• Consults with management. Provides written guidance. Participates with management in the assessment of external audit findings and responds as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs.
• Maintains coding knowledge and billing regulations associated with DRGs, CPT coding, ICD diagnosis and procedures coding and changes in CMS regulations.
• Acts as mentor and subject matter expert for staff.
• Performs other duties as assigned or required.

Benefits

• Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
• We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
• For accommodation requests, please contact HR Services Online at [email protected]

What This Job Offers

• Job Type: Full-time
• Career Level: Senior