Professional Coding Auditor - FT - Days - HIMS - Medical Records @ MV
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
- Minimum three (3) years’ experience in professional E/M clinic base coding/billing with charge-entry in demonstrating knowledge in the principals and practices of ICD-10-CM diagnosis and HCPCS reporting for all settings
- Technical aptitude for resolving basic PC hardware and software application problems with ability to perform basic troubleshooting
- Strong communication skills with technical knowledge with conference meetings
- Proficient with Excel, Word, and Outlook.
- Demonstrated ability to work productively, accurately, and independently with minimal supervision or assistance from coworkers
- Comprehensive analytical and problem solving skills in compiling statistical data
- Knowledge of Medicare’s National Correct Coding initiative (NCCI) edits in reporting correct methodologies
- Ability to interact well with all levels of employees and physicians throughout the organization
- AAPC Certified Professional Coder (CPC) required
Nice To Haves
- Experience with provider training background, preferred
- AAPC Certified Risk Adjustment Coder (CRC) and Certified E/M Coder/Auditor (CEMC or CPMA), preferred
Responsibilities
- 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.
- 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.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
