Professional Coding Auditor

2 weeks ago


Mountain View, California, United States El Camino Health Full time
Job Title: Professional Coding Auditor

El Camino Health is seeking a skilled Professional Coding Auditor to join our team. As a key member of our Revenue Cycle team, you will play a critical role in ensuring the accuracy and compliance of our coding practices.

Job Summary:

The Professional Coding Auditor will be responsible for reviewing and auditing professional and clinic-based claims to ensure compliance with Official Coding Guidelines and American Medical Association CPT/HCPCS procedural coding conventions. This role requires strong analytical and problem-solving skills, as well as excellent communication and training abilities.

Key Responsibilities:
  • Conduct thorough reviews of professional and clinic-based claims to ensure accuracy and compliance with coding guidelines
  • Identify and address coding errors and discrepancies, providing education and training to providers as needed
  • Collaborate with Revenue Cycle teams to resolve claim denials and follow-up requests
  • Develop and present educational topics to providers on claim denials, trends, and external auditing outcomes
  • Coordinate audits, provider follow-up meetings, and coding education sessions
Requirements:
  • Completion of college-level coursework in ICD-10-CM and CPT coding, anatomy, and physiology
  • Minimum of three years' experience in auditing claim denial reviews for provider-based charges and billing
  • Experience with provider training and coding education preferred
  • Strong technical skills, including proficiency in Excel, Word, and Outlook
  • Excellent communication and analytical skills
Preferred Qualifications:
  • AAPC Certified Professional Coder (CPC) certification
  • AAPC Certified Risk Adjustment Coder (CRC) and Certified E/M Coder/Auditor (CEMC or CPMA) certifications preferred
El Camino Health is an Equal Opportunity Employer:

We are committed to creating a diverse and inclusive work environment that values and respects all employees. We prohibit discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition, or any other status protected by law.



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