Lead Medical Coding Quality Auditor

2 weeks ago

Denver, Colorado, United States Haugen Consulting Group, Inc. Full time
Position Overview

The Lead Medical Coding Quality Auditor plays a crucial role in overseeing the auditing processes of medical coding, ensuring adherence to both Federal and State regulations.

Key Responsibilities


- Conduct regular audits of coding practices in alignment with compliance standards and client expectations, identifying areas where further education is required and collaborating with the education team to address these needs.


- Assess the accuracy of ICD-10-CM diagnoses and CPT codes based on supporting documentation, ensuring compliance with established coding guidelines.


- Provide consultation and training to client coding personnel on best practices and coding conventions, delivering comprehensive coding insights.


- Recognize client coding requirements and proactively develop solutions by sharing industry best practices and knowledge.


- Contribute to the formulation of coding policies and procedures as requested by clients.


- Design and implement training programs tailored to organizational and employee needs, in partnership with the education team.


- Act as the subject matter expert on the interpretation and application of coding regulations and standards.


- Assist in the creation of training materials on specific topics, including articles, blogs, and resources for clients such as desk aids and newsletters.


- Collaborate in the development of new coding content for various training formats, including online and instructor-led sessions.


- Ensure timely completion of assigned tasks with a focus on quality and budget adherence.


- Prepare and deliver presentations at the executive level.


- Represent Haugen Consulting Group, Inc. professionally in all public and client interactions.


- Identify potential business opportunities.


- Document findings and outcomes from audits, providing recommendations for the implementation of new systems or procedures based on HCG documentation.


- Participate in required team meetings and coding discussions to support client needs.


- Maintain an up-to-date understanding of ICD-10-CM and CPT coding through regular review of industry literature.


Work Environment

This role is designed for remote work, requiring a reliable home office setup with high-speed internet access. The position necessitates the ability to connect to VPNs for healthcare organizations and involves routine use of standard office equipment.

Physical Requirements

The physical demands for this position include visual, verbal, and auditory communication with clients and colleagues, as well as the ability to read computer screens and type on a full-time basis.

Qualifications

- Certified Professional Coder (CPC) in good standing.
- Certified Professional Medical Auditor (CPMA) is preferred.
- A designated home office area with documented high-speed internet connectivity.
- Valid driver's license with a clean driving record.

Required Skills

- Minimum of five years of experience in ICD-10-CM and CPT professional fee auditing.
- Experience auditing Evaluation and Management (E/M) across various settings and levels of care.
- Strong knowledge of CPT surgical auditing.
- Familiarity with current teaching physician guidelines from CMS.
- Comprehensive understanding of CMS guidance related to ICD-10-CM coding and HCC coding.
- Proficient in navigating health information systems, including electronic medical records and coding software.
- Ability to work independently and exercise sound judgment.
- Strong analytical, decision-making, problem-solving, and communication skills.
- Adaptability to changing priorities while effectively organizing tasks.
- Capability to work both independently and collaboratively within a team.
- Thorough understanding of anatomy, physiology, medical terminology, disease processes, and surgical procedures for accurate coding application.
- Commitment to staying current with professional research and sharing best practices with team members.
- Proficiency in Excel and ability to produce clear audit reports.
- Maintain productivity standards and successfully pass pre-hire coding assessments.

Preferred Skills

- Additional coding credentials or certifications.
- Experience in public speaking.
- Background in educational content development.

Software Proficiency

- Familiarity with Microsoft Office products.
- Knowledge of EMR systems such as Epic, Athena, Meditech, Cerner, and other healthcare information systems.

The responsibilities outlined in this job description are not exhaustive and may be subject to change as necessary.

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