Professional Coding Auditor - FT - Days - HIMS - Medical Records @ MV

El Camino Hospital • Mountain View, CA

91d • $50 - $75 • Remote

About The Position

The Professional Coding Auditor performs reviews for professional/clinic based clinic visits and hospital setting claims reviewing provider's diagnosis and procedural coded claims in ensuring coded data is in compliance with Official Coding Guidelines and American Medical Association CPT/HCPCS procedural coding conventions. The role of the auditor is to educate providers performing services in clinic base and hospital setting in ensuring documentation meets the reporting requirements of a legal medical record supporting medical necessity in adherence with payer requirements with billed charges. The auditor acts as liaison and works in conjunction with the Revenue Cycle teams reviewing claim denials with provider follow-up requests. Provides physician/clinical allied health providers with educational topics based on claim denials, trends, and external auditing outcomes. Coordinates audits, provider follow-up meetings, and supports the clinic-based management teams with coding education questions/reviews with presentation material and conference meetings. Coordinates with third-party vendor auditing portal sites in exporting audits with provider follow-up emails/conference meetings. Assists with on-boarding of new staff with Epic professional billing work queues. Provides general coding coverage when required and other duties assigned in work from home position.

Requirements

• Completion of college level coursework in ICD-10-CM and CPT coding, anatomy and physiology, and medical terminology.
• Minimum of three (3) years' experience in auditing claim denial reviews for provider base charges/billing.
• Experience with provider training background, preferred.
• Minimum three (3) years' experience in professional E/M clinic base coding/billing.
• Technical aptitude for resolving basic PC hardware and software application problems.
• Strong communication skills with technical knowledge for conference meetings.
• Proficient with Excel, Word, and Outlook.
• Demonstrated ability to work productively, accurately, and independently.
• Comprehensive analytical and problem solving skills in compiling statistical data.
• Knowledge of Medicare's National Correct Coding initiative (NCCI) edits.

Nice To Haves

• AAPC Certified Risk Adjustment Coder (CRC) preferred.
• Certified E/M Coder/Auditor (CEMC or CPMA) preferred.

Responsibilities

• Perform reviews for professional/clinic based clinic visits and hospital setting claims.
• Review provider's diagnosis and procedural coded claims.
• Ensure coded data is in compliance with Official Coding Guidelines and AMA CPT/HCPCS coding conventions.
• Educate providers on documentation requirements for legal medical records.
• Act as liaison with Revenue Cycle teams on claim denials.
• Provide educational topics based on claim denials and trends.
• Coordinate audits and provider follow-up meetings.
• Support clinic-based management teams with coding education.
• Coordinate with third-party vendor auditing portal sites.
• Assist with onboarding of new staff with Epic professional billing work queues.
• Provide general coding coverage when required.

Benefits

• Reasonable accommodations for qualified individuals with disabilities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees