The South Bend Clinic

  • Certified Coder - Auditor

    Location US-IN-South Bend
    Location : Name Commerce Center
    Business Office
    Monday- Friday 8-5p
    1.0 (80 Hours)
  • Job Description

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    POSITION: Certified Coder - Auditor


    POSITION SUMMARY: Position audits medical charts for coding and billing accuracy. Provides audit summaries, and graphs statistics to compare how physicians are trending against national benchmarks. Responsible for initial and continuous education to all providers who need coding assistance. Solely responsible for annual evaluation and management (E/M) chart audits. Performs prospective and retrospective reviews to ensure billing is consistent with documentation; makes recommendations for improvement and works collaboratively to establish action plans to affect positive change. Identifies within the audit process areas of opportunity in reimbursement and compliance. Must possess knowledge of Federal payer regulations, and be able to communicate this information to providers. Ultimately uses clinical coding skills to positively impact the documentation and billing record.





    1. Audits medical record documentation to identify key elements associated with the appropriate CPT, HCPCS and diagnosis code.
    2. Compares the audit outcome to that of the provider and/or fee ticket.
    3. Provides prospective review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements, while adhering to regulations prohibiting unbundling and other questionable practices.
    4. Prepares reports to providers and Administrative staff which summarizes audit findings, compares this information to MGMA statistics, and conveys key opportunities for improvement in compliance, reimbursement and clinical documentation.
    5. Trains, instructs, and/or provides technical support to providers as appropriate regarding coding compliance documentation and regulatory provisions, and third party payer requirements.
    6. Interacts directly with physicians and providers to provide direct coding assistance in the electronic health record (EHR) and via paper processes.       This education serves to promote better chart audit outcomes, and also provides a better documented record.
    7. Conducts annual audits in accordance with Compliance Plan; however, will perform weekly audits under the direction of the Compliance Committee if needed to improve coding and billing efficiency and education.
    8. Makes recommendations and updates to fee tickets, charge masters, diagnosis masters and EHR physician pick-lists.
    9. Collaborates with Coding Manager and Business Office Director in the implementation of coding policies.
    10. Researches, analyzes, and responds to inquiries regarding coding and billing denials when needed.
    11. Ensures strict confidentiality of medical records.
    12. Provides ongoing communication and feedback directly to physicians and providers wherever needed. Uses excellent written and verbal communication skills at all times.
    13. Attends coding conferences and workshops to receive updated coding information and changes in coding and/or regulations. Conducts training meetings with providers and staff.
    14. Follows established departmental policies, procedures and objectives, compliance objectives safety and environmental standards.
    15. Exhibits computer system knowledge and proficiency necessary to perform job functions.
    16. Demonstrates the attitudes and behaviors of The South Bend Clinic Service Standards.
    17. Performs other duties as assigned when appropriate.
    18. Adheres to HIPAA guidelines set forth in Clinic policies and procedures.





    High School graduate or GED equivalent is required. Certified Coding Specialist (CCS); Certified Coding Specialist – Physician Based (CCS-P); Certified Professional Coder (CPC); or Registered Health Information Technician (RHIT) required. Minimum of 3 years coding experience preferred. Minimum of one year physician auditing experience preferred.


    Knowledge, Skills, and Abilities:

    Prior experience directly related to the duties and responsibilities specified is required. Advanced knowledge of medical terminology and medical coding. Knowledge of patient care charts and patient histories. Knowledge of legal and policy constraints pertaining to patient billing. In depth knowledge of auditing concepts and principles, as well as coding and compliance regulations. Computer literacy as well as knowledge of Microsoft Outlook, Excel and Word. Ability to analyze and problem solve. Ability to gather data, compile information and prepare reports. Ability to communicate effectively, verbally and in writing with colleagues, managers and physicians.   Ability to provide guidance and coding support to employees in any clinical area.   Ability to work with staff and physicians to successfully implement new coding policies and procedures in any clinical setting as well as formulate training materials. Ability to communicate technical information to non-technical personnel. Ability to assess provider compliance with billing regulations and define areas in which additional training is required to meet standards. Ability to use independent judgment to manage and impart confidential information. Ability to meet departmental deadlines.


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