The Professional Fee Auditor performs coding quality audits of professional fee services to ensure compliance, appropriateness, and accurate code assignments in accordance with CMS, payer, and regulatory guidelines. They provide actionable feedback and education to providers and coding staff to improve documentation, coding accuracy, and reimbursement integrity.
Key duties include:
- Performing coding audits of professional fee records.
- Evaluating the quality of clinical documentation to identify incomplete or inconsistent documentation impacting data quality.
- Auditing codes and professional fee services from medical records according to ICD-9, CPT, HCPCS, and CMS guidelines.
- Developing and coordinating education and training on appropriate documentation, accurate coding, and coding trends.
- Meeting with providers or coders to review audit findings and recommend improvements.
- Preparing written reports of audit findings by provider/practice.
- Maintaining up-to-date knowledge of coding guidelines related to professional services.
Requirements & Qualifications
- Active coding credential: CPC or AHIMA coding credential.
- Minimum 3 years coding experience in physician coding and physician billing.
- Working knowledge of CMS coding and documentation rules and regulations.
- Ability to identify and apply rules and regulations relative to professional service audits.
- Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing.
- Ability to analyze and identify opportunities for documentation improvement.
- Excellent verbal and written communication skills.
- Ability to maintain confidentiality.
- Knowledge of medical terminology, CPT-4, ICD-10, and HCPCS coding.
- Organized, detail-oriented, and able to multi-task.
- Professional appearance and communication skills.
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago
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