Medical Coding Auditor

CenterWell

1d • Remote

About The Position

The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements.

Requirements

• CPMA AND CRC certifications
• At least ONE of the certifications from AAPC or AHIMA: CPC - Certified Professional Coder (AAPC), CCS - Certified Coding Specialist (AHIMA), CCS-P - Certified Coding Specialist-Physician Based (AHIMA)
• 2 or more years of outpatient coding experience (Preferably in a risk adjustment setting)
• Knowledge of several reimbursement methodologies, including risk adjustment and fee for service
• Must maintain annual continuing education requirements and remain in good standing with the certification governing body
• Will work in a goal-oriented environment that is production and quality driven
• Passionate about contributing to an organization focused on continuous improvement
• Proficient in all Microsoft Office applications, including Word and Excel
• Public speaking / group presentation skills
• Ability to travel locally and overnight within Conviva and CenterWell markets per business need

Nice To Haves

• CDEO
• Bachelor's Degree
• Experience with Athena and eCW (Electronic Medical Records)
• Outpatient auditing experience, preferably in a risk adjustment setting

Responsibilities

• Verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions
• Confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines
• Use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines
• Prepare written summaries of audit findings
• Present verbal audit feedback and provide education upon completion of the medical record audit
• Respond to or clarify internal requests for information
• Support and participate in process and quality improvement projects
• Partner with business associates from other departments to understand their needs and concerns, and help develop system solutions
• Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed.
• Follow established guidelines/procedures
• Help code capacities

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level