Professional Coding Auditor

El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward.  We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care.  Come join the team that makes this happen.

Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.

FTE

1

Scheduled Bi-Weekly Hours

80

Work Shift

Day: 8 hours

Job Description

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.

Qualifications

1. Completion of college level coursework in  ICD-10-CM and CPT coding, anatomy and physiology, and medical terminology

2. Minimum of three (3) years’ experience in auditing claim denial reviews for provider base charges/billing

3. Experience with provider training background, preferred

4. 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

5. Technical aptitude for resolving basic PC hardware and software application problems with ability to perform basic troubleshooting

6. Strong communication skills with technical knowledge with conference meetings

7. Proficient with Excel, Word, and Outlook. 

8. Demonstrated ability to work productively, accurately, and independently with minimal supervision or assistance from coworkers

9. Comprehensive analytical and problem solving skills in compiling statistical data

10. Knowledge of Medicare’s National Correct Coding initiative (NCCI) edits in reporting correct methodologies  

11. Ability to interact well with all levels of employees and physicians throughout the organization

License/Certification/Registration Requirements

• AAPC Certified Professional Coder (CPC) required

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

Ages of Patients Served

This position will serve all age groups.

Salary Range:

$52.38 - $78.57 USD Hourly

The Physical Requirements and Working Conditions of this job are available.  El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)

An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.