Medical Coding Auditor

2 weeks ago

San Diego, United States San Ysidro Health Full time
Position Summary:

Responsible for performing audits to ensure quality, completeness in the documentation and the accuracy of level of service and coding according to CPT and ICD- 10 guidelines. Prepare audit findings for Coding Manager, Director of Revenue Cycle, and Medical Director and to Corporate Compliance Committee.

This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely; there will be a bi-monthly travel expectation. Additional on-site presence may be required based on business need.

Essential Functions of the Job:
  • Conducts random patient encounter audits per provider for each Clinic site as required by Corporate Compliance Policies and Procedures.
  • Prepare audit work documents from the Electronic Health Record (EHR) system and the Electronic Practice Management (EPM).
  • Abstract the medical documentation from the chart note into the coding program to evaluate the accuracy of the level of service (Evaluation and Management) codes that were submitted.
  • Review the provider's chart note for completeness, accuracy and compliance according to CPT and ICD-10 guidelines and with both Center for Medicare & Medicaid Services (CMS) and payer requirements.
  • Provide a comprehensive summary report and the supporting documents of the audit finding results and conclusion in an Excel Spreadsheet.
  • Analyze audit findings and Practice Management reports to identify patterns, trends, or variation in coding documentation practices.
  • Communicate the results of the audit findings via written report and oral presentation to Corporate Compliance Committee, Health Information Services Manager, Director of Revenue Cycle, Medical Director and providers.
  • Assist in the development of provider specific training, as well as corrective action plans based on the audit results.
  • Monitor coding performance to ensure lasting improvement.
  • Track and identify trends and risk areas based on audit findings and data analysis.
  • Exercise confidentiality and sensitivity while reviewing with individual physicians their audit findings and making suggestions for coding improvement.
  • Maintains all records and data logs of the yearly audits performed.
  • Adheres to SYHealth's Core Competencies and Behavior Standards in their day- to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment.

Additional Duties and Responsibilities:
  • Adheres to departmental policies and procedures, protocols and processes.
  • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
  • Maintains a clean, safe and organized work area always.
  • Attends meeting as required and participates in committees as directed.
  • Performs other related duties as assigned or requested.

Job Requirements

Experience Required:
  • 1 year in related coding or auditing.

Education Required:
  • High School Diploma or GED Equivalent.

Certifications and Licenses Required:
  • Current Procedural Coder (CPC) or CPC-A Certification from the American Academy of Professional Coders/Apprentice (AAPC) or AHIMA American Health Information Management Association certification required. Valid Driver's License and Vehicle Insurance.

Verbal and Written Skills Required to Perform the Job:
  • Must have excellent English speaking and writing skills.
  • Very strong presentation skills required.

Technical Knowledge and Skills Required to Perform the Job:
  • Extensive knowledge of medical terminology, human anatomy and physiology.
  • Knowledge of diagnostic tests, procedures, pathology terms and drug reference books. Knowledge of ICD-10-CM and HCPCS/CPT, HCC coding & abstracting procedures.
  • Superb organizational ability and exceptionally analytical
  • Proficient in typing skills and experience with using computers and software systems
  • Experience and knowledge with Microsoft Office software.

Equipment Used:
  • General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.

Working Conditions and Physical Requirements:
  • This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely; there will be a bi-monthly travel expectation. Additional on-site presence may be required based on business need.
  • Driving and occasional travel required.
  • Prolonged periods of sitting, and occasional walking and standing.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

Other details
  • Pay Type Hourly
  • Min Hiring Rate $31.52
  • Max Hiring Rate $43.63

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