Coding Auditor

As the coding Auditor, you'll play a crucial role in ensuring healthcare documentation integrity, proficient medical coding and auditing, and comprehensive provider education. Your contributions will be pivotal in guiding our healthcare clients towards adherence to stringent documentation, coding, and billing guidelines. This role is designed for those seeking professional growth, offering opportunities to make a substantial impact in the field.

Key Responsibilities:

• Conduct thorough and independent audits covering coding, documentation, and billing compliance across various specialties, including Evaluation & Management (E/M) assignments, third-party billing, surgical note reviews, and documentation.
• Uphold the highest ethical standards while mentoring both new and seasoned healthcare providers and leaders.
• Lead risk-based audits, perform regulatory research, initiate investigations, and actively participate in claims reviews.
• Execute meticulous quality assurance reviews and promptly escalate compliance issues to service line leadership.
• Innovate, refine, and update training materials; organize and lead training sessions tailored to current organizational needs.
• Analyze diverse documentation, conduct interviews, and maintain detailed work papers.
• Systematically document audit findings and deliver concise final reports.

Qualifications:

• Associate’s degree or a minimum of 5 years in healthcare coding/auditing.
• Certification in coding through AAPC, AHIMA, or equivalent; CPMA or similar certification preferred. Experience in Risk Adjustment and/or inpatient coding is advantageous.
• Comprehensive understanding of healthcare operations, physician coding compliance, medical terminology, patient care standards, and clinical documentation.
• Previous auditing experience in a healthcare consulting firm environment preferred.
• Proficiency in government regulatory processes and guidelines.
• Expertise in HIPAA, data privacy, and data security processes.
• Experience engaging with regulators overseeing public or private health insurance carriers.
• Ability to interpret and implement Federal and State regulations, coding, and billing specifications.
• Proficiency in Microsoft Office applications (Outlook, Excel, Word, PowerPoint, SharePoint).
• Strong skills in providing constructive feedback, critical analysis, and solving complex coding challenges.
• Excellent written and verbal communication skills for clear interactions.
• Strong interpersonal skills for effective collaboration across management levels, providers, and physicians.
• Detail-oriented, self-motivated, and committed to maintaining confidentiality and integrity in all actions and decisions.