Coding Auditor 25-00417

General Summary
Performs data quality reviews on subpecialty medical group provider in-patient and outpatient records to validate ICD-10 codes, CPT codes, and clinical documentation. Audits provider (physician and midlevel) records for accuracy of principal and secondary diagnoses and/or procedures and ensures compliance with all reporting and documentation requirements. Educates providers, coders, and charge entry personnel on coding guidelines and documentation requirements. Provides coding support to coding and billing staff.

Responsibilities

• Audits medical records for accurate CPT coding assignment. Compiles reports with analysis of findings from medical record audits.
• Ensures the selected CPT code supports the clinical documentation contained in patient records.
• Consistently meets established productivity targets for record audits. Audits all established provider medical records on a biannual basis. Maintains audit logs.
• Compiles reports with analysis of findings from medical record audits.
• Ensures the selected CPT code supports the clinical documentation contained in patient records.
• Consistently meets established productivity targets for record audits.
• Communicates verbally and in writing with providers to validate observations and suggest additional and/or more specific documentation.
• Designs and implements, in collaboration with the Revenue Cycle Manager, tools to support medical record physician documentation.
• Develops and implements plans in coordination with the Revenue Cycle Manager for both formal and informal education of providers.
• Communicates the benefits of complete clinical documentation to participants.
• Trains new employees on coding and documentation guidelines.
• Assists the Revenue Cycle Manager with evaluation of coding activities and the performance evaluation of revenue cycle personnel as needed.
• Performs coding procedures as needed and warranted.
• All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credentials, and Experience

• Education: Associate Degree in a related field
• Credential: Certified Professional Coder (CPC)
• Experience: Five (5) years of inpatient/outpatient coding and auditing experience

Preferred Education, Credentials, and Experience

• Education: Bachelor's Degree in a related field
• Credential: Certified Professional Coder (CPC)
• Experience: Coding in a multi-specialty group practice setting

• Direct Placement, Benefited
• Full-Time, On-Site