Coding Auditor
1 month ago
GI Alliance is seeking an experienced Coding Auditor & Provider Educator.
Duties of this position include, but are not limited to, the following:
Position Purpose
The Compliance Auditor I will be responsible for researching and analyzing the medical record where there is a discrepancy in coding, validating the coding and preparing reports that summarize audit findings and provide recommendations for corrective actions, if warranted.
Responsibilities/Duties/Functions/Tasks:
* Conducts physician chart audits to identify incorrect coding and prepares reports of findings and issues.
* Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities for fraud and abuse prevention and control.
* Reports coding patterns identified within the audit process to the Director and identifies corrective measures to problems.
* Provides second-level review of organization's billing performance to ensure compliance with legal and procedural policies and adherence to regulations that pose risk.
* Provides feedback to providers regarding billing and documentation policies and procedures and educates on conflicting or non-specific documentation.
* Performs quality assessment of records, including verification of medical record documentation (both electronic and handwritten).
* Abstracts and assigns the appropriate ICD-10, HCPCS/CPT codes, including Level I & II modifiers, as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
* Maintains current knowledge of coding guidelines and relevant federal regulations using current CPT, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.
* Manages time effectively to meet all required deadlines for operational and department needs.
* Collaborates in a team environment with the Department Director and other staff regularly.
* Enhances professional growth and development through in-service meetings, educational programs, conferences, etc.
* Performs other related duties as required and assigned.
Qualifications
Qualifications
Education: High School Diploma/GED, Professional Coding Certification with American Academy of Professional Coders AAPC: Certified Professional Coder (CPC) is required. Obtain Certified Professional Medical Auditor (CPMA) within one year of employment.
Experience: Minimum of 3 years' experience in health care operations and coding experience required; Evaluation and Management and/or Gastroenterology coding experience preferred.
Performance Requirements:
* Extensive knowledge of ICD-10, HCPCS II and CPT codes
* Proficient in Word, Excel, and PowerPoint.
* Skilled in creating summary spreadsheets, documents, reports, and presentations.
* Knowledge of current third-party billing and collection regulations and requirements.
* Good interpersonal skills; written and verbal communication skills both with administrative and clinical staff.
Equipment Operated: This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Work Environment: Primarily remote, routinely requested to come into the office for collaborative team meetings in person when possible.
Physical Requirements: Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Position may involve standing, sitting, bending, and reaching. May work at computer monitors for prolonged periods with danger of eye strain and muscle pain. Could cause stress if the workload is heavy. May on occasion require light lifting of no greater than 20 pounds and some offsite travel.
Some travel required, to facilitate integration of new business, as well as business development opportunities. (10% or less)
GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.
Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.
NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.
No phone calls or agencies, please.
EEO/AA-M/F/disabled/protected veteran
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