Medical Coding Auditor - Outpatient

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

The Medical Coding Auditor - (Outpatient) is responsible for ensuring the accuracy, integrity, and compliance of medical coding practices within the organization. This role involves auditing medical records, coding data, and billing information to verify adherence to coding guidelines and regulations. The Medical Coding Auditor plays a crucial role in minimizing coding errors, preventing fraudulent activities, and ensuring that the organization meets all applicable standards and requirements.
 

Key Responsibilities to include:

• Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.

• Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.

• Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.

• Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards. Conduct workshops and seminars as needed.

• Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement. Present reports to management and relevant stakeholders.

• Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency.

• Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.

• Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications.

Knowledge, Skills and Abilities Needed:

• Extensive knowledge of ICD-10, CPT, and HCPCS coding systems.

• Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements.

• Understanding of medical terminology, anatomy, and physiology.

• Strong analytical and problem-solving skills.

• Excellent attention to detail and accuracy.

• Effective communication and interpersonal skills.

• Ability to work independently and as part of a team.

• Ability to work remotely from a home office without on-site Supervision

• Proficiency in coding software and electronic health record (EHR) systems.

Required and Preferred Qualifications:

• High school diploma or equivalent GED required.

• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.

• Active certification is required.  Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well.  Other Medical Coding certifications may also qualify.

• At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.

• Coding for emergency care, observation, and same day surgery is preferred.

• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.

• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant’s Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED