Coding Auditor

The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility / technical fees including detection and correction of documentation, coding and billing errors and / or medical necessity of services billed. Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed including ICD-10 / CPT / HCPCS and other third party payor codes, DRG and EAPG assignments, medical necessity of the services, reimbursement overpayments and underpayments, and compliance with other documentation, coding and billing standards. The Coding Auditor applies standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to report audit results.

Qualifications : Minimum Education

Associate's Degree Candidates with 3 years of coding experience in lieu of the degree requirement will be considered. .

Minimum Work Experience

2 years as a Certified Coder preferably with experience in pediatric coding and / or experience performing coding audits within an academic medical center (Required)

Required Skills / Knowledge

• Interpret and apply documentation and coding rules and regulations along with charge capture and reimbursement methodologies;
• Plan, conduct and perform coding audits;
• Work cooperatively with Medical Center administrative staff, department staff, and providers;
• Manage diverse and conflicting priorities and projects effectively and meet deadlines;
• Maintain competence in and up-to-date knowledge of healthcare billing and coding compliance requirements, practices and trends;
• Conduct detailed coding audits, reach independent decisions and logical conclusions and prepare report of findings;
• Interpret medical records progress notes, hand written and electronic chart entries, provider orders, and other related documentation;

Proficiency in the use of personal computers with Windows operating systems including Microsoft applications such as Word, Excel, Outlook, PowerPoint and Access.

Communicate effectively both verbally and in writing.

Required Licenses and Certifications

CCS, CIC, CPC, CPC- H, or COC. (Required)

CPMA and / or CEMA / C or ability to acquire within 6 months after start date. (Required)

Functional Accountabilities

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment / Identification

Teamwork / Communication

Performance Improvement / Problem-solving

Cost Management / Financial Responsibility

Safety