Coding Investigator Auditor

Health Care Service Corporation•Tulsa, OK

2d•Hybrid

About The Position

The Coding Investigator Auditor role is responsible for conducting billing, coding, and documentation reviews of professional and outpatient claims for services in both a pre and post payment environment to validate the accuracy and adherence specific to ICD-10-CM, CPT, HCPCS and CMS coding guidelines, specific to unbundling, duplicate billing, upcoding, misuse of modifiers, violation of provider contract, medical policy adherence. Operational efficiency with coding guidelines, internal and internal policies, provider contracts, state regulations and other information to validate the claims submitted and billed. In addition, this role is responsible for conducting research, preparing documentation and communication of findings, and consulting with internal departments and staff as needed.

Requirements

Bachelor’s Degree; in lieu of degree one year of claims or coding experience may substitute for each year of college.
Certified Coding Certification (CPC, COC, CCS, CCS-P, RHIT, RHIA) or acquire within 24 months of hire.
3 years’ experience in claims processing operations and reporting systems.
2 years’ experience in auditing, or developing computer system reports.
Adherence to time management, production, and quality standards.
Professional communication skills, oral and written.
Ability to prioritize multiple assignments and manage multiple spreadsheets, documents, and reports.
Industry knowledge of Medicare regulations and payment policies, including OPPS.
Proficient in computer applications such as Microsoft Excel, Teams, PowerPoint, Word, and Outlook.

Nice To Haves

2+ years certified coding experience

Responsibilities

Conducting billing, coding, and documentation reviews of professional and outpatient claims for services in both a pre and post payment environment.
Validating the accuracy and adherence to specific coding guidelines (ICD-10-CM, CPT, HCPCS, CMS), unbundling, duplicate billing, upcoding, misuse of modifiers, violation of provider contract, and medical policy adherence.
Ensuring operational efficiency with coding guidelines, internal policies, provider contracts, and state regulations.
Conducting research, preparing documentation, and communicating findings.
Consulting with internal departments and staff as needed.