Medical Coding Auditor – Outpatient, OIG Focus

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Job Description:

  • Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes
  • Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards
  • Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation
  • Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards. Conduct workshops and seminars as needed
  • Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement. Present reports to management and relevant stakeholders
  • Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency
  • Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes
  • Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications

Requirements:

  • High school diploma or equivalent GED required
  • Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred
  • Active certification is required
  • Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well
  • At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types
  • Coding for emergency care, observation, and same day surgery is preferred
  • Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.

Benefits:

  • medical, dental, vision
  • HSA/FSA options
  • life insurance coverage
  • 401(k) savings plans
  • family/parental leave
  • paid holidays
  • paid time off annually
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