The Senior Coding Auditor performs detailed audits of medical cases to ensure accuracy of assigned codes, charges, availability of documented medical records, medical accounts and compares the cases with the itemized bill and overall procedures. They review and audit current and retro accounts, report audit outcomes regarding charge errors, savings or losses for the facility, data processing errors, hospital charging system performance, and documentation within medical records and itemized bills.
Works cooperatively with Associate Directors/Director in identifying process improvement initiatives related to coding and charging of hospital services. Provides guidance and support to Coding Auditors as needed. Assists with quality assurance reviews, data analysis, workload monitoring, distribution, and training.
Approximately 75% of time allocated to Chart/Coding Review, 25% to other duties.
- Bachelor's degree or equivalent in Nursing, health-related field, Accounting, Finance, Management, or related field.
- Minimum 2 years related experience or equivalent combination of education and work experience.
- Proficient with PCs, word processing, spreadsheets, databases.
- Experience with payment review systems, hospital info systems, clinical record info systems.
- Knowledge of insurance terms, payment, coding methodologies, revenue codes CPT/HCPCS, billing and coding edits (CCI, OCE, MUE, LCD/NCD), billing and reimbursement practices.
- Strong quantitative, analytical, communication skills.
- Understanding of medical records, hospital bills, insurance/payment terms, charge master.
- Knowledge of regulatory requirements (JCAHO, CMS, Medicaid).
- Knowledge of coding guidelines ICD-10-CM, CPT-4; CMS memos, ancillary department functions.
- Knowledge of hospital clinical and financial IT applications.
- Understanding of charge capture and creation process.
- Familiarity with UB-04, itemized statements, medical records.
- Preferred: clinical experience in acute care.
- Preferred Certifications: AHIMA, RHIT, RHIA, CCS, CPC-H.
Location
New York, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$76,632 - $95,790
Remote work allowed
No
Posted
1 week ago