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Coding Auditor

2 months ago

Reno Nevada, United States ReqOverflow Full time
Job Description

ReqOverflow is seeking a highly skilled Coding Auditor - Hospital Billing Specialist to join our team. As a key member of our Coding and Compliance department, you will be responsible for ensuring the accuracy and completeness of medical coding assignments, as well as promoting compliance with coding guidelines and regulations.

Key Responsibilities:
  • Audit medical records to assess the accuracy and completeness of medical coding assignments.
  • Review documentation to ensure proper code assignment based on diagnosis, procedures, and services rendered.
  • Verify that coding practices comply with current coding guidelines, regulations, and industry standards.
  • Identify coding errors, discrepancies, and potential compliance issues through comprehensive review and analysis.
  • Provide feedback and education to coding staff and healthcare providers on coding guidelines, documentation requirements, and compliance issues.
  • Develop and implement best practices and training programs to improve coding accuracy and compliance.
  • Stay abreast of updates and changes in coding regulations, reimbursement policies, and healthcare industry trends.
  • Generate reports and metrics to track coding audit findings, trends, and compliance metrics.
Requirements:
  • Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding.
  • Expert knowledge of Anatomy and Physiology of the human body, Pharmacology, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.
  • Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers.
  • Knowledge of clinical content standards.
  • Ability and knowledge of the appeal process to ensure accurate reimbursement.
  • Utilize critical thinking and problem-solving abilities.
  • Ability to work well with others.
  • Uphold a strong work ethic characterized by honesty and dependability.
  • Demonstrate personal time management skills, including organization, prioritization, and multitasking.
  • Adherence to company policies, procedures, and directives.
Preferred Qualifications:
  • A minimum of 5-8 years of previous facility experience required.
  • A minimum of 2 years of previous medical coding auditing experience required.
  • Experience and knowledge in coding compliance criteria for all patient encounter types preferred.