Coding Auditor

4 weeks ago

Manila, Philippines Health Business Solutions LLC Full time

Health Business Solutions (HBIZ), founded in 2002, is a high-impact, transitional outsourcing firm that provides near-term relief to overturn denied claims and accelerate cash while concurrently working with providers and health systems to address Revenue Cycle under-performance.

The Coding Auditor will perform detailed reviews of medical documentation and coding, ensuring accuracy, compliance with coding standards, and adherence to regulations such as ICD-10, CPT, and HCPCS. The auditor will work closely with coding teams, providers, and clinical staff to educate on coding practices and provide feedback for continuous improvement.

Key Responsibilities:

  • Review and Audit Medical Records : Conduct audits of medical records to ensure that coding is accurate, compliant with payer requirements, and adheres to national coding guidelines (ICD-10, CPT, and HCPCS codes).
  • Ensure Regulatory Compliance : Ensure all medical coding aligns with applicable federal, state, and local laws and regulations (including Medicare and Medicaid guidelines).
  • Identify Errors and Gaps : Detect and correct coding discrepancies, missing or incomplete documentation, and over- or under-coding issues.
  • Provide Feedback and Education : Educate coding staff and healthcare providers on accurate coding practices, documentation improvement, and regulatory changes.
  • Prepare Audit Reports : Compile detailed audit reports highlighting findings and corrective actions needed, including recommendations for process improvement.
  • Support Revenue Cycle : Work closely with the revenue cycle management team to ensure proper coding for billing and reimbursement.
  • Keep Up to Date with Coding Changes : Stay current with updates to coding standards, compliance regulations, and healthcare laws.

Required Skills & Qualifications:

  • Certifications : Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or similar certification is required.
  • Experience : Minimum of 2-3 years of medical coding or auditing experience and experience with risk adjustment audits, clinical documentation improvement (CDI), and payer audits.
  • Knowledge of Coding Systems : Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and familiarity with DRG, E/M coding.
  • Bachelor's degree: in Nursing, or any Medical or Health Information Management or a related field.
  • Attention to Detail : Exceptional attention to detail with the ability to identify coding and documentation errors.
  • Communication Skills : Strong written and verbal communication skills, with the ability to provide feedback to coding teams and clinicians.
  • Analytical Skills : Ability to analyze data and develop insights that drive improvements in coding accuracy and compliance.
  • Familiarity with Compliance Standards : Knowledge of healthcare compliance standards such as HIPAA, Medicare, and Medicaid regulations.
  • Proficiency in Software : Experience using coding and billing software (e.g., Epic, 3M Encoder, Cerner, or other EHR systems).
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