Coding Auditor

UHS•Tredyffrin Township, PA

About The Position

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve. POSITION OVERVIEW Coder Certification Required.The Coding Auditor is responsible for determining that ICD-10, CPT-4, and HCPCS coding is supported by the clinical documentation in the medical record as well as validating medical necessity per CMS Local Coverage Determination (LCD). Applies working knowledge of medical terminology, anatomy, CPT-4 and ICD-10 codes and coding skills/ experience to ensure timely and accurate audits of clinical documentation as requested.

Requirements

High School Graduate/GED required. Associates Degree preferred.
3 -5 years of experience required working in a healthcare (professional) billing, health insurance, coding, auditing or equivalent operations work environment.
Auditing experience required.
AAPC CPC Certification required.
Healthcare (professional) billing, CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies.
Excellent organization skills, attention to detail, research and problem solving ability.
Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.
Service-oriented/customer-centric.
Strong computer literacy skills including proficiency in Microsoft Office.

Nice To Haves

Understanding of the revenue cycle and how the various components work together preferred.
Billing software (e.g., Cerner, Epic, IDX) experience are highly desirable.

Responsibilities

Performs accurate and timely review of clinical documentation as requested to ensure that ICD-10, CPT-4 and HCPCs coding is supported by the clinical documentation is medical record. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report accurate and timely findings to the Coding Manager. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured.
Provides feedback on audit and education plans and materials and makes recommendations for updates that will enhance the auditing process.
Maintains an expanded knowledge base CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies. Meets continued education guidelines to maintain current AAPC CPC certification
Exercises good judgement in escalating identified coding trends that may negatively impact productivity, quality or revenue to enhance clinical documentation to support codes billed, drive consistency across IPM, mitigate claim denials, expedite reprocessing of claims and maximize opportunities to enhance front end, coding-related claim edits to facilitate first pass resolution.
Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.