Coding Auditor
The Coding Auditor is responsible for determining that ICD-10, CPT-4, and HCPCS coding is supported by the clinical documentation in the medical record as well as validating medical necessity per CMS Local Coverage Determination (LCD). Applies working knowledge of medical terminology, anatomy, CPT-4 and ICD-10 codes and coding skills/ experience to ensure timely and accurate audits of clinical documentation as requested. Key Responsibilities include:
- Performs accurate and timely review of clinical documentation as requested to ensure that ICD-10, CPT-4 and HCPCs coding is supported by the clinical documentation in the medical record.
- Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report accurate and timely findings to the Coding Manager.
- Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured.
- Maintains an expanded knowledge base CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies.
- Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.
Qualifications:
- High School Graduate/GED required. Associates Degree preferred.
- 3 -5 years of experience required working in a healthcare (professional) billing, health insurance, coding, auditing or equivalent operations work environment.
- AAPC CPC Certification required.
- Excellent organization skills, attention to detail, research and problem solving ability.
- Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.
- Service-oriented/customer-centric.
- Strong computer literacy skills including proficiency in Microsoft Office. Billing software (e.g., Cerner, Epic, IDX) experience are highly desirable.
As an IPM employee you will be part of a first-class organization offering: Excellent Medical, Dental, Vision and Prescription Drug Plans Competitive Compensation & Generous Paid Time Off 401(K) with company match Tuition Reimbursement and much more!