Professional Billing Quality Coding Auditor, FT, Days,

Prisma Health-posted 1 day ago
Full-time • Mid Level
Greenville, SC
5,001-10,000 employees
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Inspire health. Serve with compassion. Be the difference. Job Summary The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perform specialty reviews as identified by Coding and Education leadership. Prepares a summary of findings and presents reports to leadership on a monthly basis. Will assist with training coders on identified opportunities for improvement. Will also assist in preventing coding denials when applicable. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.

  • Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings.
  • Performs review of all coders within the department and prepares a summary of findings.
  • Provides training to coders on identified issues found during reviews.
  • Codes charges for professional billing based on review of clinical documentation.
  • Identifies and assists with the resolution of coding issues and process improvement.
  • Assists in creating edits to prevent denials.
  • Assists in creating a standardized process for front end coding including the development of training materials.
  • Mentors and trains coders on correct coding guidelines.
  • Interacts with other departments to assist in resolving coding.
  • Performs other duties as assigned.
  • Education - Bachelor's degree in Business or related field of study
  • Experience - Three (3) years multi-specialty coding experience in professional billing
  • CPC Certified Professional Coder (AAPC) and CPMA Certified Professional Medical Auditor (AAPC)
  • Knowledge of medical terminology and basic anatomy and physiology with the ability to apply coding concepts to ensure correct coding.
  • Analytical skills.
  • Working knowledge of Epic, Encoder Pro, 3M
  • Ability to work independently and manage multiple projects consistently
  • Proficient computer skills (word processing, spreadsheets, database)
  • Data entry skills
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