Jun 07, 2024

Medical Coding Auditor-Educator (Certified Professional Coder)

  • Prism Vision Group
  • 420 Mountain Ave 4th floor, New Providence, NJ 07974, USA
Full Time (CPC) Certified Professional Coder (COPC) Certified Ophthalmology Coder

Job Description

The Medical Coding Auditor Educator will report to the Director of Compliance and will be responsible for assisting with the creation of and further coordinating the Compliance Audit Plan within the Compliance department. This will include conducting internal billing and coding audits as well as coordinating audits conducted by our auditing vendor. The Coding Compliance Auditor will create accurate coding audit reports and will facilitate physician training where applicable.

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.

Required Experience Level

Intermediate Level

Minimum Education

Associate's Degree

Minimum Experience Required

4-6 years

Applicant Location

US residents only