Medical Coding Auditor

Full job description

Job Overview:
We are seeking a detail-oriented and experienced Auditor to join our team. As an Auditor, you will be responsible for reviewing and analyzing medical records, coding, and billing practices to ensure compliance with industry standards and regulations. Your expertise in medical office procedures, medical coding systems, and medical terminology will be essential in conducting accurate audits.

Duties:
- Review medical records, coding, and billing documentation to identify discrepancies or errors
- Conduct audits of medical claims to ensure compliance with coding guidelines and regulations
- Analyze coding practices to identify potential areas of improvement or risk
- Verify accuracy of diagnosis codes (ICD-10) and procedure codes (DRG)
- Ensure proper documentation of medical services provided
- Collaborate with healthcare providers and staff to address audit findings and implement corrective actions
- Stay updated on changes in coding guidelines, regulations, and industry best practices
- Prepare detailed audit reports with findings and recommendations

Review documentation to ensure proper code assignment based on diagnosis, procedures, and services rendered.

Verify that coding practices comply with current coding guidelines, regulations, and industry standards.

Adhere to compliance requirements and standards for clinical documentation in accordance with the American Medical Association and the Centers for Medicare and Medicaid Services Coding and Documentation guidelines, regulations of federal and state agencies, and third-party payers.

Identify coding errors, discrepancies, and potential compliance issues through comprehensive review and analysis.

Ensure timely completion of monthly audit reviews as established by HIM Coding Leadership.

Provide feedback and education to coding staff and healthcare providers on coding guidelines, documentation requirements, and compliance issues.

Perform special audits/chart review and provide written findings to requested HIM Coding Leader.

Develop and implement best practices and training programs to improve coding accuracy and compliance.

Stay abreast of updates and changes in coding regulations, reimbursement policies, and healthcare industry trends.

Generate reports and metrics to track coding audit findings, trends, and compliance metrics.

Report/record all documentation and coding issues that require follow-up reviews to coding manager.

Maintain confidentiality and adhere to ethical standards in handling sensitive patient information.

Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Incumbent must have skill set to:

Address appeals and review needed information for insurance denials to facilitate expedient resolution and reimbursement.

Participates in mandated Medical Record Review processes.

Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.

Knowledge of discharge disposition and reimbursement outcomes.

Adherence to Health Information Management (HIM) Coding policies.

Adherence to The Joint Commission (TJC) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.

Responsibility for maintaining coding certification and continuing education.

Participates in performance improvement initiatives as assigned.

The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.

Qualifications:
- Bachelor's degree in Health Information Management or related field preferred
- Certified Coding Specialist (CCS) certification preferred
- Minimum of 2 years of experience in medical coding or auditing
- Proficient in ICD-10 coding system and medical terminology
- Knowledge of ICD-9 coding system is a plus
- Familiarity with medical collection processes and procedures
- Strong analytical skills with the ability to identify patterns and trends
- Excellent attention to detail and accuracy
- Ability to work independently and meet deadlines

Note: This is a paid position. Compensation will be discussed during the interview process.

Job Types: Full-time, Part-time, Contract, Temporary

Pay: $50,978.85 - $79,350.88 per year

Expected hours: 5 – 15 per week

Benefits:

• Health insurance

Schedule:

• 4 hour shift

Work setting:

• Clinic
• Remote
• Telehealth

Work Location: Remote

If you require alternative methods of application or screening, you must approach the employer directly to request this as Indeed is not responsible for the employer's application process.