Healthcare Coding Compliance Auditor

1 week ago


Pensacola, Florida, United States Standard Technology Full time
Job Overview

Position: 100% ONSITE

SUMMARY: The Healthcare Coding Compliance Auditor is tasked with reviewing medical documentation and coding practices to ensure adherence to federal coding standards and guidelines. This role involves the accurate assignment of ICD, CPT, and HCPCS codes, along with necessary modifiers and quantities as documented by healthcare providers. The auditor will also be responsible for training and educating medical treatment facility (MTF) personnel on coding-related matters and will play a crucial role in compliance initiatives.

1. QUALIFICATIONS:

1.1. Essential Knowledge and Skills:

  • In-depth understanding of auditing principles and practices.
  • Advanced proficiency in medical coding and billing systems, including regulatory frameworks.
  • Excellent communication and interpersonal abilities.
  • Familiarity with legal, regulatory, and policy compliance issues in medical coding and billing.
  • Awareness of current trends and developments in medical coding requirements.
  • Comprehensive knowledge of medical coding systems and documentation standards.
  • Capability to adapt medical billing protocols and data management systems to specific operational needs.
  • Ability to convey medical information clearly to both professionals and the public.
  • Capacity to exercise independent judgment and manage confidential information.
  • Proficient in problem analysis and resolution.
  • Experience in providing guidance and training to both professional and technical staff.
  • Computer literate, with familiarity in coding and auditing software, as well as office applications.
  • Understanding of medical ethics, customer service, and telephone etiquette.

1.2. Education and Certification:

  • Relevant certifications such as Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coder Specialist-Physician (CCS-P), and/or Certified Coder Specialist (CCS) are required, along with a minimum of 5 years of medical coding experience across various clinical specialties and 3 years of medical auditing experience within the last eight years.
  • Candidates with a Certified Professional Medical Auditor (CPMA) certification must have at least 2 years of medical auditing experience within the last 5 years of medical coding experience.

1.3. Continuing Education: Contract medical coders are required to obtain necessary continuing education hours at no cost to the government to maintain their national certifications.

1.4. Experience: A minimum of 5 years of medical coding experience in diverse clinical specialties and 3 years of medical auditing experience within the last eight years is essential. Expertise in ambulatory surgery coding/auditing for outpatient encounters is also required.

1.5. Work Environment: The role is primarily sedentary, involving prolonged periods of walking, standing, sitting, or bending. Daily tasks may require carrying or lifting medical records and utilizing various computer programs and monitors to effectively perform duties.

2. UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:

  • Familiarity with Armed Forces Health Longitudinal Technology Application (AHLTA).
  • Understanding of Composite Health Care Systems (CHCS) and/or MHS GENESIS.
  • Knowledge of Defense Enrollment Eligibility Reporting System (DEERS).
  • Experience with military filing systems and medical record management.
  • Proficiency in using EssentrisTM and Coding Compliance Editor (CCE) Systems.
  • Awareness of Biometric Data Quality Assurance Service (BDQAS) and MHS Coding Guidelines.

Additional Requirements: Proof of immunizations, including COVID vaccination, and a physical examination are mandatory. Candidates must obtain government security clearance, with U.S. citizenship required for this process.

Compliance Statement: This contractor and subcontractor shall adhere to the requirements of 41 CFR, which prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and mandates affirmative action to employ and advance individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.



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