Auditor, Coding and QA - Revenue Cycle Coding

REQUIRED EDUCATION / EXPERIENCE:

High school diploma or equivalent and four years of medical billing or related experience, or related training from an accredited agency. Must meet minimum qualifications of a Sr. Coder and be proficient in auditing and reporting. At least one-year analytical experience. CCA, CCS, or CCSP coding certification from AHIMA; or CPCA, CPC, CPCHA coding certification from AAPC.

PB/HB, Revenue Cycle, Coding, Charge Capture, Medicare, CMS Preferred

JOB SUMMARY:

To provide internal coding quality reviews to ensure compliance with official coding guidelines for hospital and physician coding. Review of billed charges from medical record documents to ensure that the documentation supports the billed services; to report any coding discrepancies; and to provide training to physicians and coders to eliminate any discrepancies. This position provides training and education to the Coding Staff and Medical Staff and maintains current department policies related to coding and charge posting. This position also assists with coding production, as needed, reviews and resolves coding issues related to billing, research complex coding issues and participates in process improvement related to coding and E & M management. Codes professional and outpatient technical charges for multiple clinics to ensure accuracy and optimal reimbursement from all third-party payers.

ESSENTIAL JOB FUNCTIONS:

Performs internal coding and documentation quality reviews of coded Ambulatory services and professional fee assignment of medical records to verify the accuracy and specificity of assigned codes in accordance with supporting clinical documentation.

Reviews account when requested by the Physician Billing & Revenue Cycle Department and other clinical departments to research and resolve coding issues related to billing. Reviews medical records to ascertain all appropriate diagnoses and procedures for both professional fee and ambulatory services, as needed.

Educate and offer feedback to physicians and staff as needed to ensure that documentation is complete, accurate, and compliant with guidelines.

Maintain acceptable productivity level and keep Pre/AR at or below department’s standard.

Actively participate in team functions such as team meetings, educational sessions, and team projects.

Adheres to internal controls and reporting structure

MARGINAL OR PERIODIC JOB FUNCTIONS:

Performs related duties as required.

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