Qualifications: Graduate in Lifesciences with Coding certifications : CPC, CCS. Highly experienced in surgical coding with an emphasis on orthopedic surgery.
Years of Experience: Minimum 6 years of experience and overall 8 years of experience
Job Summary
The Coding Auditor and Educator is responsible for providing coding auditing of complex services rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare, medical necessity, and NCD/LCD requirements. Professional coding auditing expertise in multiple specialties is required, including strength in E/M and surgical coding, especially orthopedic surgery, along with expertise in professional inpatient E/M services. The auditor/educator assists in providing educational training and understanding to physicians, mid-levels, clinical personnel, and revenue cycle teams. The auditor/educator will have effective communication skills via verbal and written and will be able to speak with providers and clinical team members confidently.
Qualifications
- 2+ years of relevant experience in a professional coding auditor and/or coding educator capacity required.
- 3+ years orthopedic surgery and Evaluation and Management (E/M) coding experience. Other surgical specialties considered.
- Certified coding certificate from AAPC or AHIMA, required
- Strong understanding of and experience in auditing for compliance with 1995, 1997, and 2021/2023 E/M Guidelines required
- Additional credentials such as RHIT, CCS, CPMA, or specialty designations desirable
- Physician financial reimbursement and revenue cycle understanding is preferred
- Experience presenting to physicians and other healthcare providers required
- Ability to work in a fast-paced, high-volume coding audit (5-7 encounters per hour average expected) environment with a team, which expects high-quality deliverables and accuracy to clients
- Superior communication skills, both oral and written
- Excellent project management skills
- Traits that include detail-oriented, flexible, and responsive
- Experience with multiple practice management systems
- Expert level knowledge of Microsoft Office (Word and Excel)
- An innate desire for continuous operational improvement
Responsibilities
- Conducts regular audits of coding and billing practices to ensure that they comply with regulations, identify areas for improvement, and provide training and support to staff members as necessary.
- Prepares clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating providers, coders, and management throughout the organization.
- Conducts monthly monitoring reviews of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10 CM codes, CPT’s, HCPCS, modifiers, and place of service.
- Conducts monthly monitoring reviews of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10 CM codes, CPT’s, HCPCS, modifiers, and place of service.
- Stays up-to-date with changes in coding regulations, policies, and procedures to ensure that the organization is always in compliance.
- Assists to designs, develops, and implements coding education programs for clients and staff members in the organization.
- Assists to provide education and training to coding staff, physicians, and other healthcare providers on CDI and coding best practices, including documentation requirements, coding guidelines, and compliance with regulatory requirements.
- Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA)
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