Coder Quality Auditor
The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines. Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties.
Job Responsibilities:
- Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders' comprehension and further assess ongoing education. Also assists in special project audits, as assigned.
- Educating - Assesses the educational needs of coding staff based on individual coder audit results and overall trends. Creates presentations, develops learning material, handbook and other educational materials.
- Edits/Denials/Coding - Assists operational coding team with initial coding, edits, and denials and appeals on an as needed basis.
- Training - Assists with training new and existing staff. Develops all training materials and coding aids for both formal training and use by coders in daily work. Identifies coders to be cross-trained and suggests areas for training improvement. Assists in the implementation and administration of effective systems, processes, and procedures.
- Resource - Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting AMA, CMS, and professional coding standards. Performs miscellaneous job-related duties as assigned.
- Reporting - Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW. Assists with the creation of various documents and reports as requested. Immediately provides reports related to compliance risks when requested.
Experience We Love:
- 5+ years of coding experience.
- 3+ years of auditing experience.
- Proficiency in multiple EMR's, encoders, and the Microsoft Office suite.
- Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
- Consistently achieves quality and productivity standards.
- Ability to organize and complete work in a timely manner.
- Ability to read, write and effectively communicate in English.
- Ability to understand medical/surgical terminology.
- Above average written and verbal communication skills.
Minimum Education: Associates degree or equivalent experience
Required Certifications: Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):
- CPC (Certified Professional Coder)
- CCS-P (Certified Coding Specialist-Phys Based)
- CCS (Certified Coding Specialist)
- CMPA (Certified Professional Medical Auditor)
- RHIA (Registered Health Information Administrator)
- RHIT (Registered Health Information Technician)