PHYSICIAN SERVICES CODING AUDITOR

Johnson Memorial Hospital•Franklin, IN

9h•Hybrid

About The Position

Johnson Memorial Health is seeking a Physician Services Coding Auditor to join their team. This role is responsible for abstracting information from patient records, reviewing and verifying medical codes (ICD, CPT, HCPCS), and ensuring compliance with government and insurance regulations. The auditor will work closely with providers to correct any identified errors, conduct chart audits, and query providers for clarification when documentation is inadequate. Additionally, this position involves educating providers on new coding guidelines, providing support for compliant coding practices, and assisting with revenue integrity by reviewing insurance denials and claims. The role also includes performing daily claim reviews in the Electronic Medical Record (EMR) and electronic claims scrubber, potentially assisting with new employee training, and upholding the Mission and Values of Johnson Memorial Health.

Requirements

High school diploma or equivalent required.
Certified Professional Coder (CPC) from the AAPC or Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician (CCS-P) certification from the AHIMA is required or must be obtained within 1 year of hire.

Nice To Haves

Additional certifications in designated specialty preferred (example: COSC, CGSC, CPMA, COBGC, CGIC, CEMC, CFPC, CPEDC, etc.).
Previous medical billing experience preferred.

Responsibilities

Abstracts pertinent information from patient records for provider services.
Reviews ICD, CPT, or HCPCS codes, including modifiers, assigned by providers.
Works with providers to correct any codes or charges when errors are identified.
Reviews medical records for diagnoses that meet medical necessity according to CMS guidelines.
Reviews and interprets provider notes using CPT and ICD coding books and/or software.
Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations.
Conducts chart audits for provider documentation and queries providers for clarification when documentation is inadequate or unclear.
Educates JMH Physician Network providers on new coding guidelines, CPT code additions/deletions/modifications, and ICD code additions/deletions/modifications.
Provides guidance and support for physician practices to ensure compliant coding and documentation practices.
Works directly with Patient Accounts Department to prevent denials and ensure revenue integrity.
Provides support for providers to ensure charge capture of CMS quality payment incentive programs.
Reviews insurance denials to analyze the causes & identify suitable solutions.
Performs daily review of claims in Electronic Medical Record (EMR) as assigned for coding review.
Responsible for claim corrections and claim submissions as appropriate.
Performs daily review of claims in electronic claims scrubber as assigned for coding review.
May assist with training of new employees.
Performs other related duties as assigned.
Clearly communicates and continuously supports the Mission and Values of Johnson Memorial Health.
Conducts all activities in compliance with applicable laws, regulations, standards, and Johnson Memorial Health policies and procedures.