The Professional Coding Auditor & Educator works collaboratively with physicians, other healthcare professionals and coding staff to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to all patients, as well as ensuring compliant reimbursement of patient care services.
Responsibilities
Responsible for reviewing and analyzing all aspects of the department clinical documentation and care to ensure timely, accurate, and compliant charge capture and submission
Works as an educational resource to inform and educate departments on the latest government regulation and requirements, including CMS, the State, and payer regulations related to these charges
Collaborates with Coding Supervisor to ensure clinical documentation in high-risk areas is consistent and complete
Identifies inconsistencies in medical reports and works with healthcare staff to improve charge capture and error correction
Audits providers on documentation and assigning accurate CPT and ICD-10 codes
Minimum Qualifications
High School diploma or equivalent
Active CPC or CCS Certification from AAPC or AHIMA required
3+ years of hands-on auditing experience (not just coding) required
Professional billing experience in an urgent care or multi-specialty environment required
Direct experience educating physicians/providers on documentation and coding requirements required
Experience using coding resources/tools (e.g., AMA guidelines, payer policies, online resources) to support audit decisions required
Energy, enthusiasm, and the ability to work under pressure in a high volume, fast paced environment with high growth
Key Attributes that will Promote Success in this Role
Knowledge of insurance payers, the AR/revenue billing lifecycle and appealing denied claims
Strong Critical thinking
Experience in billing software and EMR systems, Epic experience a plus
Extremely organized with a strong attention to detail
Motivated, dependable, and flexible with the ability to handle periods of stress and pressure
Stay up to date on coding changes and updates
Ability to work within a team environment and maintain a positive attitude
#INDmisc
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr