Quality Analyst / Coding Auditor I

Physicians' Choice is currently seeking a highly proficient and seasoned Medical Coding Auditor specializing in Evaluation and Management (E/M) services, with a comprehensive understanding of Emergency Medicine, to join our esteemed team. If you possess extensive expertise in current E/M coding guidelines and have a strong background in auditing, we invite you to apply for this exceptional opportunity.

Job Description:  As a Medical Coding Auditor you will play a vital role in ensuring accurate and compliant coding practices within our organization. You will be responsible for conducting detailed audits of medical records, coding documentation, and related billing processes to verify compliance with established coding guidelines, regulatory requirements, and internal policies.

Responsibilities:

Perform comprehensive audits of medical records, coding documentation, and billing processes.

Evaluate the accuracy, completeness, and appropriateness of medical coding, including CPT, ICD-10-CM, and HCPCS codes, ensuring compliance with applicable coding guidelines (e.g., AMA, CMS, and payer-specific guidelines).

Identify and communicate coding and documentation deficiencies, errors, or areas for improvement to coding staff, providers, and management, providing guidance and education as necessary.

Collaborate with cross-functional teams, to resolve coding and documentation issues, optimize reimbursement, and ensure regulatory compliance.

Stay updated on current coding and billing guidelines, regulations, and industry best practices, sharing knowledge with the coding team and contributing to the development and implementation of coding education programs.

Analyze coding trends, patterns, and audit findings to identify opportunities for process improvement, enhanced accuracy, and increased revenue integrity.

Maintain strict confidentiality of patient information and adhere to HIPAA guidelines and other privacy regulations.

Qualifications:

Minimum of 5 years of experience as a Medical Coding Auditor, preferably with a focus on Evaluation and Management services for Emergency Medicine.

Extensive knowledge of E/M coding guidelines and principles, including appropriate code selection, documentation requirements, and auditing methodologies.

Strong understanding of CPT, ICD-10-CM, and HCPCS coding systems, with the ability to accurately interpret and apply coding guidelines and conventions.

Proficient in medical terminology, anatomy, physiology, and disease processes relevant to Emergency Medicine.

Current certification as a Certified Professional Coder (CPC) or equivalent, such as CCS-P, CRC, or CPMA.

Excellent analytical and critical thinking skills, with the ability to review and analyze complex medical records and coding documentation.

Detail-oriented with a high degree of accuracy and precision in work.

Effective communication and interpersonal skills to collaborate with various stakeholders.

Up-to-date knowledge of coding and billing regulations, compliance requirements, and industry trends.

Familiarity with electronic health record (EHR) systems and coding software.

Join our dedicated team and contribute to our mission of delivering high-quality service while ensuring accurate coding practices and regulatory compliance. We offer a competitive salary, comprehensive benefits package, and opportunities for professional growth and development.

In compliance with California's pay transparency law, the anticipated base salary for this role is $26.00 - $34.00 per hour. The final base salary will be determined by a variety of factors, including the candidate’s experience, skills, and location.