Job Description
Job Purpose The Coding Auditor will be responsible for inpatient and outpatient coding and auditing for various specialties. This role will also be responsible for preparing and presenting audit results. Duties and Responsibilities Perform coding audits and compliance audits for providers, including physicians and mid-level providers. Prepare reports of audits and present audits to internal and external parties as needed Complete accurate application of appropriate coding and documentation guidelines, including but not limited to, E&M and surgery documentation guidelines, CCI guidelines, CPT/HCPCS coding guidelines, and specialty association guidance Provide physician education when necessary. This could include, but is not limited to, audit findings or edit and denial trending. Complete coding audits for our copartners’ coding WQ Work with any offsite auditors Evaluate and report on the overall quality of physician documentation that supports selected codes most specifically but not inclusive of medical necessity Adhere to local and national coverage determinations, and CCI and payer specific editing rules Ensure appropriate documentation and coding of split/shared services, teaching physician guidelines and any client specific quality assessment programs Compile, trend, analyze and report on all findings that do not meet all of the guidelines listed above Maintain a professional attitude Other duties as assigned by the management team Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications High School diploma or equivalent required CPC or CCS coding certification required from AHIMA or AAPC Minimum 5 years of coding experience and minimum 2 years auditing experience
