– Full time, permanent, Facility Outpatient Auditor
– Responsible for performing coding quality audits on a wide variety of outpatient services.
– The position requires this auditor to be highly proficient in the proper assignment of ICD-10-CM, PCS, CPT, HCPCS and modifier codes.
– Demonstrated ability to provide direction to coding staff as it relates to coding integrity, effective and compliant query application and adherence to facility procedures.
– Provides written, detailed rationale and supporting evidence for recommendations on audit findings.
– Delivers educational feedback to coding staff regarding audit findings.
– Provides guidance to coding staff and management in identifying and resolving coding issues.
– Collaborates with the clinical documentation improvement team for conflicts between code assignments.
– Identifies documentation improvement opportunities that impact coding accuracy.
– Initiates physician queries for clarification of documentation in the medical record to achieve accurate code assignment and coding integrity.
– Reviews and researches billing edits.
– Assists with DRG denials from payers including researching and writing appeal letters.
– Ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.
– Performs other duties as assigned including training/mentoring of new staff and performing research related to special projects
Other Job Functions:
– Reports results of audits to departments and committees as assigned
– Identifies opportunities for intradepartmental and interdepartmental operational improvements.
– Participates in coding program related meetings, physician and staff education, staff development, departmental activities and in-service opportunities.
– Five years progressive coding or coding review experience in an acute care setting, including auditing
– Comprehensive understanding of coding guidelines, Coding Clinics, CPT Assistant, CCI edits, and appropriate coding references along with the ability to employ these coding resources to audit findings.
– Excellent interpersonal verbal and written communication skills to accurately relay information to internal and external customers.
– Excellent organizational skills with ability to trend and track audit findings effectively.
– Excellent problem-solving skills, the ability to work independently, and to perform under pressure in a teamwork manner with diplomacy and tact.
– Proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint.
– American Health Information Management Association (AHIMA) certification required such as RHIA, RHIT or CCS
– An associate’s degree or higher in a health-related discipline
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