Medical Auditor

Methodist Health System•Dallas, TX

18d•Remote

About The Position

Remote or On-Site (Dallas, TX) Employment/Education History Requirements : Certifications : High school education or equivalent; some college credit; Bachelor’s degree preferred. Certified Professional Coder ( CPC ) certification from AAPC or Certified Coding Specialist – Physician-based ( CCS-P ) certification from AHIMA with the appropriate level of experience for auditing and abstracting. Preferred : Certified Professional Medical Auditor (CPMA) certification from AAPC Experience/Knowledge : 2+ years of multispecialty auditing medical documentation experience for appropriate E&M level and CPT assignment or 4-5 years of multispecialty coding experience. Thorough knowledge of anatomy/medical terminology. Proficient with Microsoft Word and Excel. Experience with Epic preferred. Ability to communicate effectively via written and verbal communication. Ability to research payer and federal regulatory sites. Excellent knowledge of guidelines for ICD-10-CM, CPT®, HCPCS, and regulatory guidance. Knowledge of CMS split/shared, teaching physician, incident-to, and scribe documentation guidelines. Critical thinking skills to assess and comprehend documentation in various forms within the medical record. Methodist Medical Group is the North Texas physician organization affiliated with Methodist Health System. Our fast-growing network of providers includes more than 60 healthcare clinics, an urgent care clinic, and a virtual care service known as MethodistNOW. Our employees enjoy not only competitive salaries but also the outstanding benefits package of Methodist Health System, which includes medical, dental, and vision insurance; a matched retirement plan; an employee wellness program; and more. The opportunities for career growth are equally generous. Our affiliation means being part of an award-winning workplace: 150 Top Places to Work in Healthcare by Becker’s Hospital Review , 2023 Top 10 Military Friendly® Employer, Gold Designation, 2023 Top 10 Military Spouse Friendly® Employer, 2023

Requirements

High school education or equivalent; some college credit; Bachelor’s degree preferred.
Certified Professional Coder ( CPC ) certification from AAPC or Certified Coding Specialist – Physician-based ( CCS-P ) certification from AHIMA with the appropriate level of experience for auditing and abstracting.
2+ years of multispecialty auditing medical documentation experience for appropriate E&M level and CPT assignment or 4-5 years of multispecialty coding experience.
Thorough knowledge of anatomy/medical terminology.
Proficient with Microsoft Word and Excel.
Ability to communicate effectively via written and verbal communication.
Ability to research payer and federal regulatory sites.
Excellent knowledge of guidelines for ICD-10-CM, CPT®, HCPCS, and regulatory guidance.
Knowledge of CMS split/shared, teaching physician, incident-to, and scribe documentation guidelines.
Critical thinking skills to assess and comprehend documentation in various forms within the medical record.

Nice To Haves

Certified Professional Medical Auditor (CPMA) certification from AAPC
Experience with Epic preferred.

Responsibilities

Audit coder I & II assigned E&M levels and surgical/procedural codes against provider documentation for quarterly compliance program auditing requirements.
Audit coder III denial actions and resolutions.
At the direction of the Director/Audit Manager, perform random risk audits for areas of concern to assure documentation standards are being met for billing/coding purposes.
Assist in training and education of coders and staff on compliance billing and coding principles for government and commercial payers.
Assists in research and responding to coder questions via e-mail.
Assists in production coding in order to maintain volume in work queues for end of month.
Assists in all other areas within the coding/auditing department as directed by Director/Audit Manager.
Adhere to patient and office confidentiality guidelines as outlined by the policies and procedures of MMG and MHS as well as HIPAA, red flag regulations, and any other polices that relate to compliance to federal program guidelines.
Supports the mission, vision, values and strategic goals of the Methodist Health System and the Methodist Medical Group.
Other duties as assigned.