Facility Outpatient Auditor - ED, SDS, OBS, I&I
About The Position
The Facility Outpatient Auditor performs retrospective reviews of facility outpatient medical records and coding for ED, SDS, OBS, and I&I. The role identifies coding and billing errors, evaluates root causes, reviews diagnosis, procedure, and billing codes for regulatory and procedural compliance, and supports accurate reimbursement. This is a remote position, and the employee must live in the United States. The auditor provides coding guidance, training, and feedback to internal coding staff; researches and responds to compliance, coding, denial, and billable-service questions; identifies physician query opportunities; and helps improve coder productivity and accuracy. The position also monitors coder progress and quality, prepares reports and deliverables, and maintains professional coding credentials and knowledge of coding and reimbursement requirements. The role requires adherence to coding ethics, privacy and security rules, company policies, and compliance practices.
Requirements
- Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered.
- At least 2 years of experience coding and/or auditing for inpatient and outpatient facilities; 3 years is preferred.
- At least 1 year of customer service support experience.
- Strong verbal and written communication skills.
- Ability to prioritize workload, meet deadlines, and maintain quality and accuracy.
- Strong analytical skills, initiative, resourcefulness, and attention to detail.
- Ability to work as a team member and with multiple, diverse clients and projects.
- Ability to work with minimal supervision.
- Familiarity with hospital outpatient billing processes and hospital APC assignment and associated coding and documentation.
- Proficiency in Microsoft Office applications, including Word and Excel.
- Ability to navigate a variety of EMR environments and review handwritten charts.
- Regular, predictable, and punctual attendance.
- Must live in the United States.
Nice To Haves
- Experience with telecommuting and electronic medical record systems.
- CPC or CCS coding certification preferred; the posting also lists CPC, COC, CCS, RHIT, and RHIA as preferred credentials.
Responsibilities
- Perform complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to applicable AHA, CMS, AMA, Clinic Coding Clinic, and CPT Assistant guidance.
- Analyze audit findings to identify root causes of coding errors and help prevent their recurrence.
- Provide second-level review of diagnosis, procedure, and billing codes for compliance with legal and procedural requirements and reimbursement rules.
- Research, analyze, and respond to inquiries about compliance, inappropriate coding, denials, and billable services.
- Provide technical support, training, and feedback to internal coding staff on coding compliance, documentation, regulations, payer requirements, and medical necessity.
- Protect patient health and client information and follow ethical coding standards, official coding guidelines, and compliance practices.
- Suggest and submit physician queries based on documentation and clinical needs.
- Prepare deliverables for coders as required.
- Report work time and production accurately and on time.
- Communicate respectfully with coworkers to promote teamwork and knowledge sharing.
- Provide management and appropriate staff with schedules of planned work activities, events, sites, and changes.
- Maintain coding credentials and knowledge of coding, reimbursement methodologies, and compliance issues through education.
- Monitor the progress and success of each coder.
- Maintain coder accuracy at the stated minimum goal of 95% and keep QA review percentages as close to 10% as possible.
- Identify and resolve coding quality problems or issues in a timely manner, and maintain awareness of issues that could affect coding quality.
- Assist in designing systems that improve coder productivity and coding accuracy.
- Provide monthly reports and status reports to the senior manager as requested.
- Participate in corporate training and meetings and company-provided education.
- Align conduct with AHIMA's Standards of Ethical Coding, the Company’s Code of Ethics and Business Conduct, and the Company’s Ethics and Compliance Program.
- Interpret coding guidelines for accurate code assignment and identify the impact of documentation on code assignment and reimbursement.
- Comply with internal policies and procedures and privacy and security requirements, including protection of confidential company information and Personal Health Information.
- Perform facility inpatient/outpatient auditing and coding work.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
