Position: Senior Clinical Coding Quality Auditor
Department: FPF Prof. Billing Office
Schedule: Full Time
POSITION SUMMARY:
The Senior Clinical Coding Quality Auditor conducts independent audits of Emergency/Observation and Outpatient professional fee services. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines. Prepares written reports of findings and leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Also responsible for providing assistance with coding inquiries from providers, coding, staff, etc. This position requires knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties. Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.
JOB REQUIREMENTS
EDUCATION:
Associates Degree (or direct work experience equivalent to at least 2 years)
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA
EXPERIENCE:
Minimum of 2 years experience conducting high complexity Emergency, Observation and Outpatient coding/auditing to include compliance, and billing processes.
KNOWLEDGE AND SKILLS:
- Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.
- Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
- Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
- Able to code moderate/high complexity work.
- Understands, retains, and is able to research coding billing rules, regulations, and requirements.
- Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
- Able to share/transfer knowledge or train co-workers, peers, billing managers on coding - Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
- Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
- Able to provide cross-coverage of multiple specialties.
- Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
- Proficient with computer applications (MS Office etc.), Excellent data entry skills
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
ESSENTIAL RESPONSIBILITIES / DUTIES:
- Performs Pro Fee and Outpatient Coding/charging Audits
- Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians, coders and coding vendors in accordance with professional standards, organizational policies and procedures, laws, and regulations.
- Creates and communicates clear and accurate audit findings to physicians, departments and vendors which include references for authoritative guidance.
- Performs research related to compliance and coding issues.
- Schedules meetings with Stakeholders.
- Ensure compliance with coding guidelines
- Assist in creating and updating coding reference materials and presentations as needed.
- Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.
- Communicate with Management regarding trends, issues or assistance needed.
- Maintains an accurate record of time spent on all assignments.
- Maintain coding certification.
- Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
- Maintains productivity standards set forth in Departmental Policies and procedures.
- Review and respond to coding questions.
- Ensure billed service is being accurately coded.
- Performs other duties as needed. IND123
Must adhere to all of BMC’s RESPECT behavioral standards.
(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).
Equal Opportunity Employer/Disabled/Veterans
