Outpatient Coding Auditor

Outpatient Coding Auditor

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a talented individual for an Outpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the EAPG, ASC and APC payment systems.

What You Will Do

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise to substantiate conclusions. Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Consistently achieves productivity and quality performance standards established by management.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs
• Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

What We're Looking For

• One or more active professional credentials through AHIMA or AAPC: CPC, COC, CCS, RHIA, RHIT; required
• 2+ years experience of outpatient medical record coding and/or auditing; required
• Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
• Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc.

What You Should Expect In This Role

• Remote (work from home) environment within the United States
• Benefits on first day of employment
• Clear path to advancement with training and leadership