Certified Medical Coder

Description

POSITION SUMMARY

The Coding Quality Auditor is responsible for conducting thorough audits of outpatient encounters to validate the accuracy of code assignments and ensure compliance with ICD-10, CPT, and CMS guidelines. This role requires advanced proficiency in medical coding, attention to detail, and a strong understanding of applicable regulations. The auditor will collaborate closely with clinicians to communicate coding standards and documentation requirements effectively, supporting overall accuracy and quality in the revenue cycle process.

ESSENTIAL DUTIES AND RESPONSIBILITIES (Included but not limited to the following);

• Learn and be prepared to train providers on Value-Based Billing practices and procedures.
• Perform both retrospective and prospective coding audits to ensure accuracy and compliance.
• Prepare detailed audit findings and deliver targeted education to providers.
• Develop educational guidelines and training materials for providers and clinical staff, including nurses and lab technicians.
• Conduct onboarding and training for new providers on Evaluation and Management (E/M) leveling and Medicare visit documentation.
• Collaborate with and provide guidance to our billing partner on billing and coding-related issues or inquiries.
• Offer recommendations to improve documentation practices in order to optimize reimbursement and enhance collections.
• Attend quality meetings with payers to gather requirements related to HEDIS measures and incentive programs; collaborate with the Clinical Informatics Manager to develop provider support plans for meeting these measures.
• Research documentation, CPT/ICD-10 coding, and insurance billing guidelines for a variety of healthcare services and provider types.
• Identify and implement new revenue-generating programs and reimbursement opportunities.
• Provide coding support and guidance to billing specialists as needed.
• Perform additional duties as assigned by the Revenue Cycle Manager.

KNOWLEDGE, SKILLS, AND ABILITIES

• Minimum of 3 years of experience in medical coding.
• Must hold one or more of the following:(CPC, COC, CRC, CPMA)
• Proficient in computer usage, including Microsoft Word, Outlook, and Excel. 
• Solid understanding of general office practices and procedures.
• Customer service-oriented, highly organized, and detail-driven.
• Must have excellent grammar usage. 
• Strong knowledge of medical terminology.
• Excellent grammar and written communication skills.
• Demonstrates effective problem-solving abilities.

Requirements

Demonstrates the ability to work effectively and consistently with minimal direct supervision.

Communicates clearly and professionally with staff, physicians, and the public.

Displays a strong commitment to resolving issues through effective problem-solving techniques.

Possesses excellent organizational skills and strong communication abilities, with the capacity to engage effectively with diverse individuals.

Maintains a courteous, understanding, and professional demeanor in all interactions with patients, visitors, colleagues, and medical staff.

Reliable and dependable, with a flexible schedule to meet departmental needs Must have excellent grammar usage. 

Presents a neat, approachable, and professional appearance at all times.

Must be willing to travel as required based on business needs.

EDUCATION AND EXPERIENCE

High School diploma or equivalent 

Medical Auditing: minimum of 1 year

FQHC billing guidelines

eClinical Works software knowledge