SCOPE OF ROLE

It is the primary function of the Coding Auditor is to serve as a coding expert resource for the Coding staff, providers, and support staff. They will act as the first line of coding support, ongoing training and education of coding staff to improved documentation, and best coding practices and to ensure compliance with company standards, Medicare, OIG, AMA, and health insurance payer policies.

ROLE RESPONSIBILITIES

• Monitors, and evaluates work performed by coders; reports any issues to the Coding Manager.
• Monitors and reports medical record documentation to identify potential issues. Reports unusual and complex issues. Recommends action plans and suggests processes for improvements.
• Works with Coding Manager to establish, implement, and maintain a formalized review process for coding and documentation compliance. Monitors and adheres to the audit schedule. Analyzes audit results, identifies trends, and presents audit/review findings, potential issues, and their root causes to ensure audit results are disseminated and understood. Provide education based on audit findings.
• Participates in educational activities to maintain current credentials, as well as enhance knowledge and skills. Attends department staff meetings and aids other departments as requested by managemen
• Special Projects

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Current coding certification through AAPC (CPC) or AHIMA (CCS)
• Current coding auditor certification (AAPC) for at least 2 years.
• Minimum of 5 years overall coding experience with a minimum of 3 years in Risk Adjustment.
• 2 to 3 years in risk adjustment with multiple models (ACA, Medicare, Medicaid, and Commercial) and mapping.
• 3 + years of healthcare revenue cycle management, billing, and collection-related work experience. General understanding of professional fee billing processes and procedures.
• Current knowledge of coding guidelines and current CPT, ICD-10, and HCPCS coding, fee schedule reimbursement methodology, and regulatory requirements for provider coding and reimbursement.             
• Working knowledge of key coding concepts, such as CPT modifiers, surgical packages, medical record documentation requirements, and multiple procedure guidelines. Proficient in analyzing statical data
• Bilingual: English and Spanish
• Strong knowledge on medical terminology, medical abbreviations, pharmacology, and disease processes.
• Deep expertise in finding coding resources and answering specific coding questions.

LICENSURES AND CERTIFICATIONS

• One or more of the following accreditations: CPC, CCS, CPMA, RHIA
• Risk adjustment and auditing credentials desire: CRC, CDEO.

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Travel will be required to Medical Centers office (70%). This is not a work at home position.