See JD Key Responsibilities
- Perform comprehensive provider-side (professional billing) coding audits for inpatient and outpatient physician services
- Review and validate E&M levels of service in accordance with current coding guidelines
- Validate medical necessity based on Medicare, Medicaid, and commercial payer requirements
- Audit and validate ICD-10-CM, ICD-10-PCS (as applicable), CPT, and HCPCS coding for professional services
- Evaluate physician documentation to ensure accurate code assignment and appropriate level of care
- Conduct charge validation, charge entry review, and charge correction recommendations
- Identify documentation gaps, coding discrepancies, and compliance risks
- Provide real-time and retrospective provider education to improve documentation and coding practices
- Collaborate with CDI, Revenue Cycle, Compliance, and Billing teams to ensure alignment
- Review and interpret Explanation of Benefits (EOBs) and assist with coding-related denial resolution
- Support denial prevention initiatives and revenue integrity strategies
- Ensure compliance with HIPAA regulations and organizational policies
- Utilize Epic EMR and related systems for audit workflows and reporting
- Participate in internal audits, quality reviews, and performance improvement initiatives
- Maintain detailed audit documentation, reporting, and productivity metrics
#J-18808-Ljbffr