Outpatient Auditor

We are seeking a talented individual for a remote Outpatient Coding Auditor position (Professional and Facility). Responsibilities include performing coding reviews of medical records and documentation to determine correct coding, accessing systems to audit medical records, documenting findings, and providing policy/regulatory support. The candidate must have extensive experience in outpatient coding audits and recommend documentation improvements to ensure accurate coding and billing.

Key duties:

• Understand, interpret, and apply coding guidelines for quality audits
• Audit outpatient facility and professional encounters for code assignment accuracy
• Review medical records for accurate diagnoses, procedures, units, mapping, and modifiers
• Validate claims, including ICD10CM, CPT, HCPCS codes
• Communicate clear audit findings and recommendations in writing
• Identify documentation issues impacting coding accuracy and advise on improvements
• Research billed unlisted procedure codes for accuracy
• Maintain productivity and quality standards
• Stay current with AHA Official Coding and Reporting Guidelines, CMS directives
• Complete required CEUs to maintain coding certification
• Attend trainings to enhance clinical policy knowledge
• Promote a culture of service excellence and accountability

Minimum requirements:

• 4+ years experience in outpatient medical record coding and/or auditing
• Ability to audit complex outpatient encoding accurately
• Proven skills in creating audit reports and maintaining productivity
• Pass prehire coding assessment
• Expert knowledge of ICD10CM, ICD10PCS, APC, ASC, HCPCS, CPT coding methodology
• Knowledge of disease pathophysiology and drug utilization
• Proficiency in Microsoft Office and virtual meeting tools
• RHIT/RHIA or AAPC/AHIMA certifications; specialty certifications in E/M and surgical coding preferred

Physical Requirements:

• Sedentary work with prolonged computer use
• Frequent communication skills
• Near visual acuity for reviewing records

Work Environment Requirements:

• Secure, quiet remote workspace protecting PHI
• Reliable high-speed internet (minimum 200 Mbps)

Company Overview:

Jzanus Consulting provides revenue integrity HIM services with a focus on coding validation, clinical documentation improvement, and cost outlier recovery for hospitals and physician organizations. The team consists of senior professionals with provider, payer, clinical, HIM, and home care experience ensuring quality and compliance.