Coding Auditor

Health Ministries Clinic•Newton, KS

1d•Onsite

About The Position

Health Ministries Clinic (HMC) is seeking a Coding Auditor (with PCP auditing experience) as a trusted expert to join our integrated care team in Newton, Kansas. This is a full-time, on-site position offering the opportunity to support patient care in a collaborative, mission-driven environment. At Health Ministries Clinic, we offer more than just primary care with a full spectrum of services including behavioral health, lab, diagnostic, pharmaceutical and dental. We are seeking an experienced Coding Auditor with a multi-speciality coding background. The Coding Quality Auditor is responsible to ensure Health Ministries Clinic's compliance with national coding guidelines, FQHC coding guidelines and regulations. The Coding Auditor plays a crucial role in minimizing coding errors and preventing fraudulent activities. The Coding Auditor is responsible to ensure accurate and consistent coding which results in appropriate reimbursement and data integrity. This role requires the ability to detect and correct discrepancies and coding errors, provide feedback and collaborate across departments to correct inaccuracies in medical documentation.

Requirements

High school diploma or equivalent GED required
Active certification is required in one or more of the following, preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), Auditing Outpatient Coding (OAC)
Minimum of three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
Extensive knowledge of ICD-10, CPT, and HCPCS coding systems
Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements
Understanding of medical terminology, anatomy, and physiology
Maintains up-to-date knowledge of medical coding guidelines, regulatory changes and industry best practices. Maintains active coding certification.
Strong analytical and problem-solving skills
Excellent attention to detail and accuracy, thorough
Effective communication and interpersonal skills, people-oriented
Effective time management
Able to follow directions and work independently
Proficiency with EHR systems, billing software, and Microsoft Office (Outlook, Word, Excel).

Responsibilities

Reviews designated claims for proper coding before submission. Corrects any errors or discrepancies.
Assists Billing Specialists with coding-related questions during billing processes
Works coding-related denials
Works closely with providers to clarify documentation and improve coding accuracy
Responds promptly to manager requests to code or review coded accounts for accuracy
Provides assistance to the leadership team and management with coding of the accounts or answering questions related to coding and workflows.
Understands payor rules, medical policy guidelines and documentation requirements (commercial and government) that affect coding
Ensures coding compliance with AMA, CMS guidelines, and state/federal regulations
Meets coding productivity and quality standards
Reviews provider medical records and audits to ensure accurate coding of diagnoses, procedures and services using ICD-10, CPT and HCPCS codes
Prepares detailed audit reports that highlight findings, trends and areas for improvement
Presents findings to management and relevant stakeholders
Effectively interacts and communicates findings with providers.
Able to communicate why a code is incorrect, what the correct code should be and why the new code is to be used
Able to communicate what changes in documentation habits needed to make accurate coding selection.
Ensure coding compliance with AMA, CMS guidelines, and state/federal regulations
Participates in special reviews or projects, as assigned
Provide new hire training for onboarding providers
Provide on-going support and education to providers
Provide education / training to Billing Specialists
Participate and provide good coding feedback during meetings, education and trainings
Takes initiative to assist others and share knowledge on official coding guidelines