Coding Auditor - Outpatient

The Outpatient Coding Auditor’s responsibility is to review medical records, clinical documentation, and claims to ensure accurate ICD-10, CPT, and HCPCs coding and compliance with CMS and coding guidelines. The role will be to apply coding principles based on industry standards and company/ client needs.

Role and Responsibilities

Validate

• CPT, HCPCs and ICD-10 coding accuracy of outpatient claims
• Apply MUE/ NCCI
• Review medical documentation to support billed services/ items
• Provide appeal responses for claims of the above types utilizing industry standards and company/client policies.
• Assist with new concept development.
• Assist with claim selection criteria.
• Maintain certifications and continuing education requirements.
• May require client communication to support findings.

Qualifications

• Coding certification in good standing. Examples: CCS, CPC, COC, RHIT, RHIA
• Strong knowledge of CPT, HCPCs and ICD-10 coding
• Strong knowledge of CMS and coding guidelines
• Knowledge of outpatient coding and payment methodologies (APC, OPPS)
• Ability to review complex medical documentation.
• Coding validation/auditing experience
• Well-developed verbal and written communication skills
• Ability to effectively prioritize tasks.
• Microsoft Office experience, specifically Excel 

Preferred Skills

• Appeals experience a plus.
• Clinical experience a plus
• Client communication experience a plus
• Concept development experience a plus
• Claim selection experience a plus.
• Experience with machine learning/artificial intelligence a plus
• Clinical Documentation Improvement experience a plus
• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Registered Nurse (RN) a plus
• Encoder, Codify, TruCode/TruBridge, 3M, WebStrat or similar experience a plus 

Mental and Physical Demands

This position will be exposed mainly to an indoor/office environment and will be expected to work in or around computers and printers.
The nature of the work is sedentary, and the employee will be sitting most of the time.
Essential physical functions of the job include typing and the repetitive motion to utilize computer software and hardware continuously throughout the day.
Essential mental functions of this position include concentrating on analytical tasks, reading information, and verbal/written communication to others continuously throughout the day.

Related Duties As Assigned

This job description documents the general nature and level of work but is not intended to be a comprehensive list of activities, duties, or responsibilities required for this position. Consequently, employees may be asked to perform other duties as required.
Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information.
Exemptions as provided under the ADA and TITLE VII of the Civil Rights Act will be observed and followed.
Reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above.