Senior Medical Coding Auditor

2 days ago


Dallas, United States Insight Global Healthcare Full time
Job DescriptionJob Description

***6-month contract-to-hire***

Job summary:

We are looking for a Senior Medical Coding Auditor and Trainer to join our team This person provides network physicians and business office staff with applicable billing/ coding and related reimbursement guidelines, to include federal/state laws and regulatory requirements affecting daily business operations. In addition, they participate in the development and maintenance of reimbursement education materials, review data reports for coding compliance and provide and/or coordinate the necessary education.

Day-to-day:

  • Provide coding and billing education as a subject matter expert in specialty specific categories.
  • Researches, prepares, develops and delivers subject matter material to present to network practice physicians, clinical team and business staff via web based, and other methods of training.
  • Educate and provide guidance related to ICD-10-CM, ICD-9-CM, CPT, HCPCS coding systems.
  • Provide guidance related to government regulations and commercial payer policies.
  • Educate and provide coding and billing guidance on all new or revised coding for drugs, technologies and procedures.
  • Prepare material through research of payer guidelines for claims denials and assist other departments with claims appeal responses.
  • Ongoing review of medical record documentation, for coding and documentation compliance.
  • Upon request, support network practices with review of medical record documentation, including but not limited to evaluation and management, medical and radiation oncology, genetic counseling, clinical research, surgical and other specialties.
  • Provides feedback and education on documentation, coding and billing.
  • Provides support and guidance for new In Market Affiliation (IMA) chart reviews.
  • Assist payer audit team with responses to payer audits including but not limited to RAC, CERT, ZPIC, SMRC, and commercial payers.
  • Participates in the development and implementation of network practice chart audit programs.
  • Collaboration with other MSH departments to provide coding and billing guidance and support.
  • Project management duties to include scheduling and coordination with multiple levels of leadership, physicians, clinical and business staff as well as RSS department and other MSH teams.
  • Review, research and respond to practice billing and coding questions.
  • Lead designated subject matter expert (SME) initiatives.
  • Collaborate, coordinate and participate in other projects and duties as needed or requested.

Qualifications:

  • High School diploma or equivalent required.
  • Minimum 10 years within the billing/coding/medical records experience required.
  • 5 years of recent certificated Coding and Auditing experience
  • Proficient in E/M, Infusion, Oncology and/or Surgery coding specialties.
  • Active CPC Certification
  • Computer proficiency with Microsoft Office Suite, including MS Word, Excel, Access, PowerPoint, and EMR systems

Plusses:

  • Project Management experience preferred.
  • CPCI Certification or other advanced coding certifications
  • Bachelor's Degree

Compensation:

$__75__/hr to $__88__/hr.

Exact compensation may vary based on several factors, including skills, experience, and education.

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.



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