CODING AUDITOR-EDU-CLINIC

Responsibilities

• Identifies and evaluates company risk areas and provides coding education developing criteria, and reviewing and analyzing findings.
• If applicable, provides corporate oversight of any current departmental coding audit programs.
• Works with coders/CDI staff and or physician office staff to educate and provide feedback with Coding/CMG management to proactively train staff and respond to issues.
• Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance in order to ensure compliance.
• Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance.
• Performs research and analysis of CPT coding, modifiers and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payers and to maximize reimbursement.
• Routinely attends coding and documentation conferences and educational sessions to stay on top of coding and documentation changes and updates.
• Works with CDI Manager on annual coding updates.
• Serves as a resource to hospital departments and physician practices to assist with coding and documentation questions.
• Works in conjunction with health information management, Revenue Integrity, patient accounting, information systems and other personnel to assist with implementation of solutions to maintain a proper compliance stance.
• Under the direction of Corporate Coding Manager and or CFO of CMG, works with the Chief Compliance Officer relative to coding, billing and reimbursement compliance issues.
• Performs continuous reviews to identify coding process improvement activities and coding education opportunities for coding, CDI and/or physician office staff.
• Responsible for detailed ICD-10 training of coding/CDI staff and/or physician practices.
• Responsible for assessing the preparedness of the coding/CDI staff for ICD 10 coding.
• Responsible for concurrent review process for ICD-10 coding utilization.
• Responsible for specific physician training develop by physician specialty key indicators required for ICD-10 documentation for coding.

Qualifications

• Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
• Minimum Experience: Three (3) to five (5) years experience in acute care coding, both inpatient and out-patient and/or physician practice.
• Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations.
• Experience in problem solving and analytical reviews.
• Must be knowledgeable in use of PC's, Windows, Excel and Word Processing.
• Must have good public relations and educational skills.
• Licensure Requirements: Certification in field of study. The following certifications are acceptable-RHIT/RHIA/AAPC, CPC, or CPMA.