Medical Coding Auditor

The Medical Coding Auditor provides technical support to medical providers, as appropriate, regarding accurate and compliant coding documentation, regulatory provisions and third-party payer requirements. This position will be responsible for conducting internal audits of medical coding and billing activities to ensure compliance with regulatory standards and guidelines. The responsibilities include reviewing and validating medical documents, identifying and correcting coding errors, and implementing corrective action plans.

Duties and Responsibilities:

1. Review and verify the accuracy of medical records, codes and billing data.

2. Conduct audits on medical coding to ensure accuracy and compliance with guidelines and regulations.

3. Review medical documents to validate diagnoses, procedures, and treatment codes.

4. Review medical records that have been reviewed and coded by the third-party billing company.

5. Investigate any discrepancies or inconsistencies in medical documentation and coding.

6. Train and provide feedback to Providers and medical coders on correct coding practices.

7. Stay current with changes in medical coding and billing regulations and guidelines.

8. Assist in the development and implementation of coding policies and procedures.

9. Assist if needed in requesting records or support.

10. Prepare and present reports on audit results and recommendations for improvement.

11. Monitor the effectiveness of corrective actions and improvement initiatives.

12. Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) and other relevant laws

13. Participate in regulatory audits and inspections.

14. Participate in medical billing meetings.

15. Other duties as assigned.

Knowledge, Skills, and Abilities

• Proven experience as a Medical Coding Auditor or similar role in healthcare.

• Excellent knowledge of medical coding guidelines and regulations, including ICD-10, CPT, and HCPCS.

• Ability to review and analyze clinical records and medical reports.

• Ability to work independently and make informed decisions based on thorough analysis and research.

• Strong analytical and problem-solving skills to identify discrepancies or inconsistencies in medical coding and billing.

• Excellent communication and presentation skills to convey audit findings clearly and concisely to healthcare professionals and management.

• Proficiency in MS Office, coding software, our EHR is e-Clinical Works.

• Attention to detail and accuracy.

• Continuous learning and adaptability to stay updated with changes in healthcare regulations and coding guidelines.

• Ability to multitask and prioritize. Excellent organizational and time-management skills.

• Ability to maintain confidentiality of privileged information obtained in the course of work

Software Access

Microsoft Office

eClinicalWorks

Minimum Qualifications

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is required.

• Associate’s or Bachelor’s degree in Health Information Management or related field is preferred.

• 3+ years coding of experience including outpatient coding skills, evaluation and management, auditing, report-writing expertise, required

• Must understand Behavioral Health Claims, and Telehealth.

Duties and Responsibilities:

1. Review and verify the accuracy of medical records, codes and billing data.

2. Conduct audits on medical coding to ensure accuracy and compliance with guidelines and regulations.

3. Review medical documents to validate diagnoses, procedures, and treatment codes.

4. Review medical records that have been reviewed and coded by the third-party billing company.

5. Investigate any discrepancies or inconsistencies in medical documentation and coding.

6. Train and provide feedback to Providers and medical coders on correct coding practices.

7. Stay current with changes in medical coding and billing regulations and guidelines.

8. Assist in the development and implementation of coding policies and procedures.

9. Assist if needed in requesting records or support.

10. Prepare and present reports on audit results and recommendations for improvement.

11. Monitor the effectiveness of corrective actions and improvement initiatives.

12. Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) and other relevant laws

13. Participate in regulatory audits and inspections.

14. Participate in medical billing meetings.

15. Other duties as assigned.

Knowledge, Skills, and Abilities

• Proven experience as a Medical Coding Auditor or similar role in healthcare.

• Excellent knowledge of medical coding guidelines and regulations, including ICD-10, CPT, and HCPCS.

• Ability to review and analyze clinical records and medical reports.

• Ability to work independently and make informed decisions based on thorough analysis and research.

• Strong analytical and problem-solving skills to identify discrepancies or inconsistencies in medical coding and billing.

• Excellent communication and presentation skills to convey audit findings clearly and concisely to healthcare professionals and management.

• Proficiency in MS Office, coding software, our EHR is e-Clinical Works.

• Attention to detail and accuracy.

• Continuous learning and adaptability to stay updated with changes in healthcare regulations and coding guidelines.

• Ability to multitask and prioritize. Excellent organizational and time-management skills.

• Ability to maintain confidentiality of privileged information obtained in the course of work

Software Access

Microsoft Office

eClinicalWorks

Minimum Qualifications

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is required.

• Associate’s or Bachelor’s degree in Health Information Management or related field is preferred.

• 3+ years coding of experience including outpatient coding skills, evaluation and management, auditing, report-writing expertise, required

• Must understand Behavioral Health Claims, and Telehealth.