Senior Coding Auditor
The Senior Coding Auditor will demonstrate expertise in coding and billing compliance.
The Coding Auditor audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed including ICD-10/CPT/HCPCS and other third party payor codes, DRG and EAPG assignments, medical necessity of the services, reimbursement overpayments and underpayments, and compliance with other documentation, coding and billing standards.
The Senior Coding Auditor applies standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to report audit results.
The Senior Coding Auditor will also serve as a subject matter expert for professional and facility/technical coding and assist in coding education for providers and/or coders as necessary.
Minimum EducationAssociate's Degree Candidates with 5 years of coding experience in lieu of the degree requirement will be considered.
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Minimum Work Experience4 years 4 Years as a Certified Coder with at least 1 year of experience performing coding audits.
Pediatric coding experience in an academic medical center strongly preferred.
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Required Skills/KnowledgeInterpret and apply documentation and coding rules and regulations along with charge capture and reimbursement methodologies;Plan, conduct and perform coding audits;Work cooperatively with Medical Center administrative staff and physicians/NPPsManage diverse and conflicting priorities and projects effectively and meet deadlines;Maintain competence in and up-to-date knowledge of healthcare billing and coding compliance requirements, practices and trends;Conduct detailed coding audits, reach independent decisions and logical conclusions and prepare report of findings;Interpret medical records progress notes, hand written and electronic chart entries, provider orders, and other related documentation;Proficiency in the use of personal computers with Windows operating systems including Microsoft applications such as Word, Excel, Outlook, PowerPoint and municate effectively both verbally and in writing.
Required Licenses and CertificationsCertification in Coding required.
CCS, CCS-P, CIC, CPC, CPC-P/H, or COC.
CPMA and/or CEMA/C preferred.
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Functional Accountabilities Performs scheduled and unscheduled independent audits of professional fee documentation, coding and medical necessity related to professional service providers such as physicians and NPPs (Non-Physician Providers), as well as facility/technical fee billing audits as assigned.
Conducts specialized and focused audits.
Evaluates the appropriateness and medical necessity of services and procedures billed based on supporting documentation.
Evaluates the appropriateness of ICD-10, HCPCS and CPT codes along with modifier usage.
Makes determinations of overpayments and underpayments and performs other related analysis and evaluations.
Adheres to the defined audit timeline and audit protocol standards.
Assists with development of the audit schedule.
Identifies services to be audited.
Applies consistent and standardized billing audit methodology for sample selection, scoring and benchmarking development and reporting of findings.
Prepares written reports of audit findings and recommendations to Children's Management and staff as appropriate.
Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD and CPT code utilization patterns, national normative data, CMS and Medicaid initiatives, and healthcare industry best practices.
Maintain knowledge of current Medicare, Medicaid and other third party payor billing and documentation requirements.
Assist in education and/or preparation of education materials for physicians, NPPs, and coding analysts.
Organizational AccountabilitiesOrganizational Accountabilities (Staff)Organizational Commitment/Identification Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication Demonstrate collaborative and respectful behavior Partner with all team members to achieve goals Receptive to others' ideas and opinionsPerformance Improvement/Problem-solving Contribute to a positive work environment Demonstrate flexibility and willingness to change Identify opportunities to improve clinical and administrative processes Make appropriate decisions, using sound judgmentCost Management/Financial Responsibility Use resources efficiently Search for less costly ways of doing thingsSafety Speak up when team members appear to exhibit unsafe behavior or performance Continuously validate and verify information needed for decision making or documentation Stop in the face of uncertainty and takes time to resolve the situation Demonstrate accurate, clear and timely verbal and written communication Actively promote safety for patients, families, visitors and co-workers Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance.
Estimated Salary: $20 to $28 per hour based on qualifications.
The Coding Auditor audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed including ICD-10/CPT/HCPCS and other third party payor codes, DRG and EAPG assignments, medical necessity of the services, reimbursement overpayments and underpayments, and compliance with other documentation, coding and billing standards.
The Senior Coding Auditor applies standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to report audit results.
The Senior Coding Auditor will also serve as a subject matter expert for professional and facility/technical coding and assist in coding education for providers and/or coders as necessary.
Minimum EducationAssociate's Degree Candidates with 5 years of coding experience in lieu of the degree requirement will be considered.
.
Minimum Work Experience4 years 4 Years as a Certified Coder with at least 1 year of experience performing coding audits.
Pediatric coding experience in an academic medical center strongly preferred.
.
Required Skills/KnowledgeInterpret and apply documentation and coding rules and regulations along with charge capture and reimbursement methodologies;Plan, conduct and perform coding audits;Work cooperatively with Medical Center administrative staff and physicians/NPPsManage diverse and conflicting priorities and projects effectively and meet deadlines;Maintain competence in and up-to-date knowledge of healthcare billing and coding compliance requirements, practices and trends;Conduct detailed coding audits, reach independent decisions and logical conclusions and prepare report of findings;Interpret medical records progress notes, hand written and electronic chart entries, provider orders, and other related documentation;Proficiency in the use of personal computers with Windows operating systems including Microsoft applications such as Word, Excel, Outlook, PowerPoint and municate effectively both verbally and in writing.
Required Licenses and CertificationsCertification in Coding required.
CCS, CCS-P, CIC, CPC, CPC-P/H, or COC.
CPMA and/or CEMA/C preferred.
.
Functional Accountabilities Performs scheduled and unscheduled independent audits of professional fee documentation, coding and medical necessity related to professional service providers such as physicians and NPPs (Non-Physician Providers), as well as facility/technical fee billing audits as assigned.
Conducts specialized and focused audits.
Evaluates the appropriateness and medical necessity of services and procedures billed based on supporting documentation.
Evaluates the appropriateness of ICD-10, HCPCS and CPT codes along with modifier usage.
Makes determinations of overpayments and underpayments and performs other related analysis and evaluations.
Adheres to the defined audit timeline and audit protocol standards.
Assists with development of the audit schedule.
Identifies services to be audited.
Applies consistent and standardized billing audit methodology for sample selection, scoring and benchmarking development and reporting of findings.
Prepares written reports of audit findings and recommendations to Children's Management and staff as appropriate.
Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD and CPT code utilization patterns, national normative data, CMS and Medicaid initiatives, and healthcare industry best practices.
Maintain knowledge of current Medicare, Medicaid and other third party payor billing and documentation requirements.
Assist in education and/or preparation of education materials for physicians, NPPs, and coding analysts.
Organizational AccountabilitiesOrganizational Accountabilities (Staff)Organizational Commitment/Identification Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication Demonstrate collaborative and respectful behavior Partner with all team members to achieve goals Receptive to others' ideas and opinionsPerformance Improvement/Problem-solving Contribute to a positive work environment Demonstrate flexibility and willingness to change Identify opportunities to improve clinical and administrative processes Make appropriate decisions, using sound judgmentCost Management/Financial Responsibility Use resources efficiently Search for less costly ways of doing thingsSafety Speak up when team members appear to exhibit unsafe behavior or performance Continuously validate and verify information needed for decision making or documentation Stop in the face of uncertainty and takes time to resolve the situation Demonstrate accurate, clear and timely verbal and written communication Actively promote safety for patients, families, visitors and co-workers Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance.
Estimated Salary: $20 to $28 per hour based on qualifications.
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