Medical Coding Auditor

Conduct data quality audits of inpatient admissions and outpatient encounters to validate coding assignments comply with official coding guidelines supported by clinical documentation in health records. Validate abstracted data integral to appropriate payment methodology. Communicate audit findings effectively through presentations, graphs, reports, and educational materials.

Responsibilities include:

• Review medical records for accurate assignment of all documented diagnoses and procedures following AHIMA ethical coding standards.
• Validate abstracted data elements including discharge disposition impacting reimbursement and MS-DRG assignment.
• Use specialized training and discretion to assign ICD-10 and CPT-4 codes.
• Maintain accuracy and consistency in coding diagnoses and procedures as well as abstracting required data elements.
• Stay current with AHA Official Coding and Reporting Guidelines, CMS directives for ICD-10-CM and CPT coding, including attending required coding seminars and updates.
• Create audit schedules and manage workflows.
• Develop effective communication materials related to audit results.
• Perform charge audits to ensure appropriate billing.
• Analyze coding, billing, documentation, and reimbursement systems for compliance issues.

Qualifications:

• Achieve 95% coding accuracy while meeting production standards.
• Pass a coding test successfully.
• Knowledge of medical terminology, ICD-9-CM, CPT-4 codes.
• Detail-oriented with ability to work independently in a virtual setting.
• Proficient in MS Office.
• Excellent interpersonal skills.
• Intermediate knowledge of disease pathophysiology, drug utilization, MS-DRG classification, APC, OCE, NCCI classifications, and reimbursement structures.
• Associate degree or equivalent combination of education and experience preferred.
• Three years hospital and consulting coding experience.
• Credentials from AHIMA and/or AAPC.
• Certified Professional Medical Auditor by AAPC.

Physical demands include visual acuity for detailed work, moderate physical activity mostly administrative, ability to exert up to 40 pounds occasionally, and repetitive motions.

Work conditions include frequent standing, walking, sitting, reaching, talking, and occasional stooping, kneeling, crouching, or crawling.