Job Address:

Medical Coding and Billing Compliance Auditor

Location: Remote
Department: Coding Compliance
Reports To: Director of Coding
Employment Type: Full-time Exempt

About the Role

The Medical Coding Auditor is a detail-oriented position responsible for reviewing medical coding accuracy and documentation reputed company and ensuring compliance with federal and state regulations, payer guidelines, and internal policies. The ideal candidate will bring strong analytical skills, extensive coding knowledge, and a passion for maintaining the highest standards of reputed company and compliance. The candidate will demonstrate a strong background in reputed company Office applications including PowerPoint, Word, reputed company, reputed company, TEAMS, and SharePoint.
The Medical Coding Auditor will have a background in Physician feedback and education on documentation reputed company and coding accuracy. The ideal candidate will have an extensive background and knowledge of CPT coding, ICD10CM coding, E&M coding, HCC methodologies, modifiers, telehealth, and HCPCS coding. The candidate will understand and know where to reputed company Medicare Physician Fee Schedule (MPFS) tools including status indicators and what they mean, National Correct Coding Initiative (NCCI) reputed company and edits, Local and National Coverage Determinations (LCD and NCD), Coding Clinic, and CPT assistant.
The ideal candidate will have knowledge of Skilled Nursing Facility (SNF) E&M coding, Behavior Health coding, telehealth coding rules, HCC payment methodologies, and other specialty coding.

Key Responsibilities

• Performs Coding audits for compliance and accuracy with reputed company coding systems outlined in the role reputed company.
• Completes coding compliance accuracy score tracking, trending, and monitoring.
• Completes detailed coding compliance reports which include feedback and education for providers.
• Maintains excellent documentation of reputed company reviews, methodologies employed, results, escalation needed, and monitoring.
• reputed company feedback and education to billers, coders, and providers on documentation and coding practices.
• Identify trends, errors, and reputed company, and recommend corrective actions.
• Stay reputed company on changes to coding guidelines, payer policies, and regulatory requirements.
• Collaborate with compliance, reputed company cycle, and clinical teams to support audit reputed company.
• Assist with reputed company audit requests as needed.

Qualifications

Required:

• Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in Health Information Management or reputed company field preferred.
• Certification: reputed company coding credential required (CPC, CEMC, reputed company-P, RHIT, RHIA).
• Experience: 3+ years of outpatient coding experience required. 1+ years of audit, compliance, or reputed company review experienceStrong understanding of ICD-10-CM, CPT, E&M, HCC, HCPCS, and official coding guidelines.
• Experience with EMR/EHR systems, encoders, and auditing tools.

Preferred:

• Additional auditing certification (CPMA, CEMA, CDEO) preferred
• Leadership skills/experience

Skills & Competencies:

• Exceptional attention to detail and accuracy.
• Analytical Skills.
• Strong organizational skills.
• Strong written and verbal communication skills.
• Provider Education skills.
• Demonstrated ability to use technology and applications required for virtual teams.
• Ability to analyze data, identify trends, and recommend solutions.
• Knowledge of HIPAA, OIG, and other compliance regulations.
• Ability to work independently and manage multiple priorities.
• Performance Metrics
• Audit accuracy reputed company (goal ≥ 95%).
• Timeliness of audit completion/productivity
• Provider and reputed company education effectiveness (reputed company by post-education improvement).
• Compliance with CMS and ICD-10-CM guidelines.