Medical Coding/Compliance Auditor

Requirements

• Minimum of 3 years of CPT and ICD-10 medical coding and auditing experience, including abstracting information from patient charts.
• Extensive experience in E/M coding and auditing, including detailed analysis and assignment of CPT, HCPCS and ICD-10 codes for multispecialty practices.
• CRC (Certified Risk Coder) coding certification and/or significant HCC coding experience required.
• Demonstrated experience with regulatory guidelines, including teaching physician settings, incident-to billing, and split/shared services, is required.

Qualifications

• Required: AHIMA - Certified Coding Specialist-Physician (CCS-P) or AAPC – CPC.
• CPMA Certification required.
• AAPC - CPC-I Certified Professional Coding Instructor -or- AAPC - CPC-I Certified Professional Coding Instructor -or- CHCA Certification from AHCAE (Association of Health Care Auditors and Educators), preferred but not required.

KEY TASKS & RESPONSIBILITIES

• Work as a part of an audit team to professionally and successfully complete client projects meeting productivity and quality standards within timely deadlines.
• Access necessary medical record documentation from client’s EMR systems.
• Complete detailed analysis of medical records for chart content and documentation requirements.
• Assign diagnostic codes based on abstract from patient medical record information according to the ICD-10-CM and CPT-4 Manuals and coding conventions and guidelines, as established by state and federal regulatory requirements.
• Utilize audit reporting tools to record audit results and create reports of results to submit for quality assurance (QA) and feedback prior to submission to client.
• Develop reports of audit results and corrective action plans based on audit findings.
• Conduct education and training sessions for internal team and clients as directed/requested.
• Educate and serve as a resource for providers regarding coding, documentation, and compliance matters.
• Cook up coordination, research, and access resources for execution of key client projects.
• Assist Managing Director, Director and Manager as requested/assigned to ensure key client projects are delivered on time, within scope, and within budget.
• Support the development and clarification of project scope and objectives, engaging all relevant stakeholders, and confirming that the project is technically feasible.
• Develop and Maintain relationships with clients and all key stakeholders.
• Review QA audit reports and make corrections and/or adjustments identified.
• Keep current with changes in government regulatory coding and compliance guidance and other third-party payers as needed.
• Maintain awareness of changes in coding auditing principles and practices and related areas to maintain professional competence.
• Utilize Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) for completion of assigned tasks.