PHYSICIAN SERVICES CODING AUDITOR (PRN)

Johnson Memorial Hospital•Franklin, IN

About The Position

The Physician Services Coding Auditor is responsible for abstracting pertinent information from patient records, reviewing assigned ICD, CPT, or HCPCS codes and modifiers, and working with providers to correct any identified errors. This role involves reviewing medical records for diagnoses that meet medical necessity according to CMS guidelines, interpreting provider notes using coding books and software, and ensuring accurate code sequencing in accordance with regulations. The auditor will conduct chart audits, query providers for clarification when documentation is inadequate, and educate providers on new coding guidelines. Additionally, the position provides guidance for physician practices to ensure compliant coding and documentation, works with the Patient Accounts Department to prevent denials and ensure revenue integrity, and supports providers in charge capture for quality incentive programs. The auditor will also review insurance denials, perform daily claim reviews in the EMR and claims scrubber, and may assist with training new employees. The role requires adherence to the Mission and Values of Johnson Memorial Health and compliance with all applicable laws and policies.

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 identified codes or charges.
Reviews medical records for diagnoses that meet medical necessity according to CMS LCD and/or NDC 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 causes and 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 including Blood and Body Substance Precautions.