Outpatient Coding Auditor

Signature Performance, Inc.•,

2d•Onsite

About The Position

The Outpatient Coding Auditor will perform quality reviews and audits of assigned staff to ensure standards are met in accordance with department and organization policy. This role requires skills in organization, prioritization, professionalism, and coaching others. The position involves managing multiple projects using problem-solving skills. The role requires advanced knowledge of ICD-CM, PCS, CPT-4, and HCPCS, as well as practical knowledge of reimbursement systems like PPS, DRGs, and APCs. The auditor will create clear and accurate audit findings and recommendations in written reports for advising and educating Coders, Auditors, Managers, and Directors. They will deliver educational feedback to coding staff, identify documentation issues impacting coding accuracy, and communicate opportunities for documentation improvement. The role also involves providing guidance to departmental staff in identifying and resolving coding issues and error trends, and offering continuing education to coders regarding changes in coding and reimbursement systems and identified areas of weakness.

Requirements

Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), Procedural Coding System (PCS), Current Procedural Terminology (CPT-4 and Healthcare Common Procedure Coding System (HCPCS).
Practical knowledge of reimbursement systems, including Prospective Payment System (PPS), Diagnostic Related Groupings (DRGs), and Ambulatory Payment Classification (APC).
Completion of a formal coding program with preference given to AHIMA and AAPC credentials (CCS, RHIT, CIC).
5+ years of progressive experience in professional medical coding/reimbursement.
Coding work experience encompassing a working knowledge of the ICD-10-CM and ICD-10-PCS; medical terminology; anatomy and physiology; and health record content.
Comprehensive understanding of coding guidelines, Coding Clinics and appropriate coding references along with the ability to employ these coding resources to audit findings.
Ability to work in multiple client systems.
Proficiency with Microsoft office applications.
US. Citizenship, naturalized citizenship, or permanent status is required for this position.
All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Nice To Haves

Cerner, EPIC and 3M 360 Encompass experience preferred
Academic medical facility auditing experience preferred

Responsibilities

Perform quality reviews and audits of assigned staff.
Ensure standards are met in accordance with department and organization policy.
Create clear and accurate audit findings and recommendations in written audit reports.
Advise and educate Coders, Auditors, Managers, and Directors throughout the organization.
Deliver educational feedback to coding staff regarding audit findings.
Identify documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy.
Clearly communicate (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Provide guidance to other departmental staff in identifying and resolving coding issues and/or error trends for improvement.
Provide continuing education to individual coders and to the coding staff concerning changes in the coding and reimbursement system as well as any area of weakness identified during the performance of coding validation reviews.