May 24, 2024

Medical Coding Auditor-Educator (Certified Professional Coder)

  • PRISM Vision Group
  • New Providence, NJ, United States
(CPC) Certified Professional Coder

Job Description

Role and Responsibilities

  • Assist the Director of Compliance in creating and further coordinating the Compliance Audit Plan.
  • Conduct internal billing and coding audits of medical record documentation and claims to identify coding errors.
  • Prepare summary reports of findings and meet with physicians and staff to provide education and training on accurate and appropriate documentation practices.
  • Research, analyze, and respond to inquiries regarding appropriate documentation and coding, denials, and billable services.
  • Identify documentation gaps and develop processes for improvement.
  • Collaborate with providers, Revenue Cycle department, Operations Directors and Managers, and others as appropriate, to coordinate billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation.
  • Collaborate with providers, Revenue Cycle department, Operations Directors and Managers, and others as appropriate, to review and/or implement codes and to update charge documents.
  • In certain instances, the Medical Coding Auditor-Educator will act as the liaison between the auditing vendor and Prism Vision Group in coordinating audits
  • Perform miscellaneous job-related duties as assigned.


Education, Training and Experience

  • High School diploma or GED.
  • Certificate in Medical Coding (CPC or similar certificate from AAPC or AHIMA) or at least 2- 3 years of experience directly related to the duties and responsibilities specified.
  • CPMA certification a plus but not required.
  • Proficiency in or experience with General Ophthalmology and/or Retina coding and/or auditing strongly preferred but not required.


Knowledge and Skills/Expected Competencies

  • Detail-oriented and organized.
  • Proficient in Microsoft Office Suite software and Windows 10.
  • Knowledge of auditing concepts and principles.
  • Familiarity with or have experience with pulling electronic medical records and reports from the EMR and billing databases.
  • Advanced knowledge of medical coding and billing systems and regulatory requirements.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Strong communication and interpersonal skills.
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation, including Medicare and Medicaid program rules
  • Detailed knowledge of medical coding and billing systems, procedures, and documentation requirements.


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