Outpatient Auditor

Job description

JOB REQUIREMENTS
We are seeking a talented individual for a remote Outpatient Coding Auditor (Professional and Facility), the consultant 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 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 audits and recommendations for documentation improvement to ensure accurate coding and billing.

The candidate must have 4+ years' experience coding and auditing facility and professional fee accounts. Must have E/M, surgery coding and auditing experience including complex surgery.

DUTIES AND RESPONSIBILITIES
Essential Functions
• Understands, interprets, and applies coding guidelines for coding quality audits.
• Audits outpatient facility and professional encounters with code assignments.
• Review of medical records to determine coding accuracy of all documented diagnoses, procedure, units, diagnosis mapping, and modifier codes.
• Review claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM, CPT, units, mapping, and HCPCS accuracy.
• Communicates clear and accurate audit findings and recommendations in writing that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organizations.
• Identify documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in writing) opportunities for documentation improvement related to coding issues.
• Reviews and research billed unlisted procedure codes to determine if a more specific code exists and should be used.
• Consistently achieves productivity and quality performance standards established by management.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10-CM and CPT coding.
• 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.
• Fosters and promotes a culture of service excellence and accountability.
• Performs all other duties as assigned.

MINIMUM REQUIREMENTS
• 4+ years' experience of outpatient medical record coding and/or auditing; required
• Ability to audit complex coding of outpatient encounters consistently and accurately
• Ability to create clear and concise audit reports and maintain productivity standards
• Must successfully pass pre-hire coding assessment
• Expert level knowledge of outpatient coding/auditing
• Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology.
• Expert level knowledge of disease pathophysiology and drug utilization
• Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers, and virtual meeting tools i.e., Microsoft Teams, Zoom, etc.
• RHIT/RHIA or certifications through AAPC, AHIMA. Prefer specialty coding certifications related to E/M and surgical specialties.
PHYSICAL REQUIREMENTS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Physical demands (sedentary)
• Stationary position: Must be able to remain in a stationary position for prolonged periods (e.g., eight-hour shift) while working at a computer.
• Repetitive motion: The employee must be able to constantly operate a computer and other office productivity machinery, which requires repeating motions that may include the wrists, hands, and/or fingers.
• Communication: Must have the ability to frequently communicate (verbally and in writing) to exchange accurate information with peers, direct supervisors, and client(s).
• Vision: Must possess near visual acuity to constantly review computer screens, medical records, and other digital documents.
• Mobility (occasional): The person in this position may occasionally need to move about inside their dedicated workspace to access books, papers, or office machinery.

WORK ENVIRONMENT REQUIREMENTS
• Dedicated workspace: Must provide a secure, and quiet workspace that is free from distraction and ensure PHI is protected.
• Connectivity: Must maintain a reliable, high-speed internet connection at minimum of 200 Mbps and a functional office setup.
• Environmental conditions: No adverse environmental conditions are expected.

Company Operating States
• Alabama - AL
• Arkansas - AR
• California - CA
• Connecticut - CT
• Florida - FL
• Georgia - GA
• Idaho - ID
• Illinois - IL
• Indiana - IN
• Louisiana - LA
• Michigan - MI
• Missouri - MO
• New Jersey - NJ
• New York - NY
• North Carolina - NC
• Ohio - OH
• Pennsylvania - PA
• Rhode Island - RI
• Texas - TX
• Utah - UT
• Vermont - VT
• Virginia - VA
• Washington - WA
• West Virginia - WV