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.
ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES:
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.