About This Role
Reviewing medical claims against provided medical records to ensure correct coding guidelines are met is the primary focus of this Medical Coding Auditor position. The role involves interpreting information, independently determining appropriate courses of action, and contributing to cost reduction by increasing payment accuracy and ensuring correct claims payment for CPT/HCPCS code assignments.
Responsibilities
- Review medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS)
- Analyze, enter, and manipulate databases
- Respond to or clarify internal requests for medical information
- Verify and ensure the accuracy, completeness, specificity, and appropriateness of procedure codes based on services rendered
- Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding
- Utilize encoders and various coding resources
- Perform CPT/HCPCS Procedure reviews
- Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
- Maintain strict patient and physician confidentiality and follow all federal, state, and hospital guidelines for release of information
- Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation, and protocols
- Complete appropriate system(s) entry regarding claim/encounter information
- Support and participate in process and quality improvement initiatives
Requirements
- CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
- Minimum of 3 years post certification experience in Outpatient Specialty Surgeries and Procedures
- Strong knowledge of CPT/HCPCS coding
- Experience reading and coding from operative reports
- Chemotherapy and/or Therapeutic Infusion experience
- Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
- Strong attention to detail
- Ability to work independently and determine appropriate course of action
- Ability to handle multiple priorities
- Comfortable working in a production-based work environment
- Strong written and verbal communication skills
- Strong analytical, organizational, and time management skills
- Working knowledge of Microsoft Office Programs (Word, Excel)
Nice to have:
- 5+ years prior coding experience
- Outpatient facility auditing experience
