Professional Billing Coding Auditor

What you need to know about this position:

• Responsible for evaluating and auditing provider coding and documentation compliance to determine appropriate code assignments for diagnoses and services performed (HCPCS/CPT codes).
• Develops quality audit reports that identify trends and educational opportunities.
• Responsible for training and educating providers, clinical staff, and departments, one-on-one and in a group setting, on all aspects of coding and documentation utilizing both oral and written direction.
• Prepares training and presentations on applicable topics.
• Serves as a resource for information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements and new coding initiatives.
• Proactively identifies areas of opportunity to improve coding quality based on audit feedback, coder questions, physician escalations, denial meetings, and other platforms and plans provider education accordingly.
• Assists in the formulation and review of policies and guidelines affecting the coding of professional services.
• Requires strong organizational skills and the ability to meet deadlines independently.
• Requires the ability to professionally interact with physicians and mid-level providers with strong skill in verbal and written communications and customer relations.
• Accurately applies ICD-9-CM, ICD10 CM and CPT-4 classification systems, utilizing Optum.
• Assists Manager with monitoring, coordinating and responding to external audits and questions.
• The hourly range for this position is between $26.65 and $40.00. Individual compensation is determined for this position through years of directly relevant experience. The hourly compensation is only a portion of the total rewards package and a comprehensive benefits program is available for qualifying positions.
• In this position you will be required to work full-time, 8:00AM-5:00PM, Monday through Friday.
• This position is partial remote eligible.

What is required for this position:

Education and/or Experience

• A minimum of 5 years of coding and audit experience required.
• 7 years of coding and/or audit experience with additional experience performing training and providing feedback to coding and physician audiences preferred.
• Previous experience in management, quality improvement, compliance, auditing and revenue cycle related activities preferred.
• Bachelor’s degree in Health Information Management or other healthcare related degree preferred.
• A score of 90% or higher on the Coding Assessment Tool is required.

Certifications, Licenses, Registrations

• One of the following is required:
• Certified Coding Specialist (CCS)
• Certified Coding Specialist – Physician Based (CCS-P)
• Certified Outpatient Coder (COC)
• Certified Professional Coder (CPC)
• Certified Inpatient Coder (CIC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Certified Professional Medical Auditor (CPMA) or Certified Documentation Improvement Practitioner (CDIP) certification preferred.