Medical Auditor

Mahec•Asheville, NC

4d•Hybrid

About The Position

Are you an experienced Medical Coder seeking a career growth? Are you a Certified Auditor interested in a new work opportunity? If so, then we want to connect with you! MAHEC is now accepting candidates for Medical Auditor. This integral role supports MAHEC's mission of educating the next generation of healthcare professionals by completing internal quality assessment reviews on Care Provider coding and effectively builds relationships with MAHEC Care Providers to educate and foster complete, accurate, timely, and consistent coding. The Auditor/Provider Educator is responsible for documentation to ensure compliance with national coding guidelines and MAHEC policies. We welcome experienced Medical Coders interested in becoming a Certified Professional Medical Auditor, and MAHEC offers an employer-sponsored pathway to CPMA certification if hired for the position! This is a hybrid work opportunity, with roughly 50-60% onsite work to support in-person collaboration and Medical Provider audit trainings, blended with dedicated work-from-home time for focused independent work during your work week. This full-time position is eligible for MAHEC's full Total Rewards Package, including healthcare coverage, pet insurance, up to 30 days PTO annually and more!

Requirements

Two (2) years of medical coding and/or auditing experience.
Proficient use and extensive working knowledge of billing procedures, application and use of ICD-10, CPT and modifiers using professional coding guidelines consistent with CMS compliance and other federal regulations.
Certified Professional Coder (CPC) and or Certified Coding Specialist (CCS) through an accredited certification board such as AAPC and or AHIMA.
Must have advanced computer skills including Microsoft Office Suite.
Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties.
Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion.
Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate.
Showing the ability to meet difficult situations with grace, professionalism, and understanding.
Adherence to MAHEC’s founding principles and incorporating them every day.
Having an analytical mind and ability to work autonomously to solve complex problems that may arise.

Nice To Haves

Three (3) or more years of medical coding and auditing experience.
Federally Qualified Healthcare Organization (FQHC) experience.
Allscripts PM/EMR Pro software experience.
Certified Professional Medical Auditor (CPMA).
Certified Risk Adjustment Coder (CRC).

Responsibilities

Conducts quality assessment reviews as pre-billing audits and include outpatient, inpatient, and surgical records.
Collaborates with the Clinical Business Office (CBO) Director and Business Office Manager to review and educate the coding team to improve accuracy, integrity and quality of patient data to ensure minimal variation in coding practices.
Develops internal audit plan in collaboration with the Compliance Officer.
Complete service based audits as needed.
Performs pre-billing and procedure audits of evaluation and management services for patient encounters by utilizing national coding and payer specific guidelines to ensure accuracy of diagnosis codes and provider documentation; track accuracy and trend data to identify areas for improvement.
Provides technical guidance and education to providers in identifying and resolving issues or errors.
Reviews claim denials pertaining to coding and medical necessity issues and collaborates with key stakeholders to implement corrective actions to include education or workflow changes.
Develops quality audit reports that analyze the data, identify trends/opportunities and proposes strategies for resolution and educational opportunities.
Stays current of coding, compliance and billing requirements by various government/regulatory agencies and payors to effectively apply this knowledge to complex coding, quality and compliance situations.
In collaboration with the Compliance Officer, helps facilitate external pre-billing audits conducted throughout the year, including but not limited to, identifying and suspending encounters, reviewing external auditor responses, follow-up with external auditor and provider education.
Engages in proactive thinking by recommending actions for improving coding compliance or workflow improvement opportunities.
Provides provider education based on the quality monitoring review findings and trends.
Orients new Residents and other Learners as needed to appropriate medical coding practices.
Assists physicians and other providers with coding presentations as needed.
Meets with Residents/Learners on a regular schedule and individually on an as needed basis to review completeness and appropriateness of patient encounter documentation in compliance with coding guidelines.
Education for new providers during their orientation process to ensure understanding of MAHEC billing and coding practices
Responds in a timely manner to inquiries from other departments regarding patient charges, appropriate diagnosis coding and other coding questions related to the revenue cycle.
Serves as a resource for department managers, staff, providers and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements and new coding initiatives.
Maintains open dialogue, promotes collaboration and good working relationships with all members actively engaged in the Revenue Cycle at MAHEC.