Evaluation and Management Auditor

Job Description

Interprets and reviews medical record documentation to ensure accurate ICD-10, CPT, HCPCS, and modifiers are assigned based on provider documentation.

Audits medical records using the 1995, 1997, and 2021 E/M CMS Guidelines to ensure compliance and accuracy.

Provides education to providers, practice staff, and coders based on audit results, coding updates, and documentation needs.

Applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.

Knowledge, Skills, And Abilities

• Expert knowledge of ICD-10, CPT, HCPCS, and coding, along with modifiers for outpatient and inpatient procedures.
• [Required] Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines [Required]
• Extensive knowledge of NCCI, MU, MUE edits and bundling guidelines.
• [Required] Demonstrates excellent written and verbal communication skills.
• Knowledgeable with Microsoft Office software.
• Ability to effectively operate equipment such as PC, web and/or teleconference.
• Ability to educate providers and staff on required documentation needs, coding updates and audit findings.
• [Required] Expert knowledge of Evaluation & Management (E&M) rules and surgical coding.
• [Preferred] Ability to explain required documentation needs to physicians, staff, and coding staff via EMR system.
• [Preferred] Experience presenting to large groups of peers or physicians/providers and leadership.

Education

• [Preferred] High School Grad or Equiv
• Technical/Vocational School [Preferred]
• Field Of Study Technical school certification in medical coding preferred
• Associate degree in Medical Billing/Coding preferred

Work Experience

• [Required] 3+ certified auditing
• [Required] 5+ physician-based coding for both e&m (outpatient/inpatient) and surgical procedures

Additional Information

N/A

Licenses And Certifications

• [Required] Certified Professional Coder (CPC)
• [Required] Certified Coding Specialist (CCS)
• [Required] Certified Coding Specialist – Physician-based (CCS-P)
• [Required] Certified Professional Medical Auditor (CPMA)
• [Required] Registered Health Information Administrator (RHIA)
• [Required] Registered Health Information Technician (RHIT)

Physical Requirements

View physical requirements

Pay Range

$23.91 - $44.46

Background Screening Requirement

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Equal Opportunity Employer

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.