Physician Coding Auditor

Physician Coding Auditor

Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoder's internal coding/auditing policies and expectations set forth by department management. The Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.

Candidates should have recent auditing and education multi-specialty experience, have been client-facing, have experience presenting or educating in-person or virtually, and ideally have expert-level Epic proficiency.

Responsibilities:

• Perform professional compliance audits of coding and documentation including surgeries, visits, and other services for multiple provider types across multiple specialties, for multiple clients;
• Accurate application of appropriate coding and documentation guidelines, including ICD-10-CM Guidelines, CPT Coding Guidelines, AHA Coding Clinics, AMA, CMS, Specialty Association/Society guidance, and others, as applicable;
• Accurate selection of CPT codes for services performed;
• Accurate selection and application of modifiers to CPT codes;
• Accurate selection and evaluation of ICD-10-CM diagnosis coding;
• Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;
• Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor-specific policies, if applicable;
• Appropriateness of documentation for split/shared or incident-to services;
• Appropriateness of provider documentation related to Teaching Physician Guidelines, FQHCs, RHCs, and HEDIS, as applicable;
• Accurately score audits utilizing proper scoring methodology;
• Identifies risk areas and provides mitigation strategies and recommendations;
• Provide detailed findings for each service reviewed on customized reports, including supporting documentation;
• Prepare and present audit follow-up education to clients;
• Prepare and present customized education materials based on the unique needs of the client remotely and on-site;
• Communicate with the Physician Audit and Education Manager on issues, trends, and audit timeline task completion;
• Stay current on all coding guidelines (including specialty - specific guidelines), and maintain credentials as necessary;
• Participate in department and education meetings;
• Maintain confidentiality and protect sensitive information;
• Exhibit professional demeanor and communication (written and verbal);
• Other duties as assigned by leadership.

Education/Experience Requirements:

• High School diploma required. Associate or BS degree preferred.
• Successful completion of at least one AHIMA or AAPC certification program with the achievement of the corresponding professional credential (e.g., CCS-P, CPC, or another applicable AAPC stand-alone credential), which must be active and in good standing.
• The AAPC CPMA credential is preferred, but not required.
• Minimum 5 years of recent physician coding experience and 3 years of recent physician auditing experience are required.
• Must be a subject matter expert on E&M and Surgical coding. Must have expert knowledge of medical terminology, anatomy and physiology, disease processes, CPT coding and guidelines by the AMA, ICD-10-CM coding and guidelines, and Medicare and Medicaid billing policies for professional services.
• Experience working independently, excellent time management, masterful research and organizational skills, the ability to switch between multiple projects, and the ability to meet project deadlines are a must.
• Experience creating and implementing audit plans. Experience educating providers one-on-one or in group settings.
• Additional skills required: Proficiency with Microsoft Word, Excel, PowerPoint, Windows, and healthcare information and billing systems.
• Experience working with Google Workspace is preferred but not required.
• Experience working remotely is preferred but not required.
• Experience working with multiple common EMRs is a PLUS.
• Experience specializing in some of the following profee areas is a PLUS: Ophthalmology, Behavioral Health, Cardiovascular/Cardiothoracic Surgery, Complex ENT Surgery (and Dental), Complex Plastic Surgery, Orthopedic Surgery, NICU/PICU, and FQHC/RHC.

About MedKoder, LLC:

• Privately held, growing company with strong values and ethics
• Professional development and education
• All positions are permanent – no contracts or sitting on a "coding bench"
• Generous paid time off, holiday pay, and flexible scheduling year-round
• Internal network of Medical Coding Industry Leaders – CEO is a Certified Coder with 20+ years of experience
• Up to 100% EMPLOYER PAID Medical, Dental, and Vision benefits for employees
• 401K and Profit Sharing
• STD, LTD, Life Insurance, and FSA Program
• Paid AAPC and AHIMA corporate memberships
• 30 Hours of CEU pay (continuance in education)
• MedKoder is recognized nationally by Modern Healthcare as Best Place to Work