Coding Auditor
1 week ago
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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