Coding Auditor

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Job Summary: The Coding Auditor performs coding audits to assure compliance with Corporate Compliance Plan standards.  This role develops, coordinates, and implements clinic wide education for coding and billing issues while serving as a resource to physicians, office staff, management and patients for coding and billing issues.  Additionally, this role coordinates successful response to regulatory bodies and insurance companies for medical record reviews and audits.

Minimum Education: High School Diploma or GED. Bachelor’s degree in Healthcare Administration or Business Administration, preferred.

Licensure, Registration and/or Certification: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

Work Experience: Minimum 3 years of hospital or physician auditing experience with 1 year of hospital or physician coding experience. Hierarchical Condition Categories (HCC) experience, preferred.

Knowledge, Skills and Abilities: Computer skills, including use of Electronic Health Records, auditing, and coding software. Demonstrated ability to audit Current Procedural Terminology (CPT) and Interventional Classification of Diseases, Tenth Revision (ICD-10) coding related to charting and billing utilizing knowledge obtained by coursework with subsequent certification and/or sufficient specialized, related experience to demonstrate advanced knowledge of coding to perform audits. Effective interpersonal, oral and written communication skills. Ability to organize and prioritize work in an efficient and effective manner to achieve goals. Uses good judgment in determining documentation sufficiency and how to best educate physicians and other providers of opportunities for improvement. Demonstrated understanding of complexities of office workflow and billing requirements. Ability to be an engaged team member and to provide value added service to all. Demonstrates flexibility in accomplishing challenging assignments.

Essential Functions and Responsibilities: Conducts coding audits of documentation of physicians and non-physician practitioners to assure compliance with documentation guidelines and the appropriate selection of CPT procedure codes and ICD-10 diagnosis codes. Communicates results of audit findings with manager, physicians, and medical director. Develops and delivers coding education specific to the needs of the requesting physicians and office staff. Collaborates to resolve patient complaints due to coding issues and in assurance of payment for services of denied services due to coding issues. Assists in review and analysis of documentation requests for audits performed by external regulatory bodies and insurance companies.

Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from a supervisor.

Working Relationships: Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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