Coding Auditor/Educator

Job Description

Job Description

Shift/Schedule: Monday - Friday 8a-5p, hybrid (3 days on site, 2 remote)

Key Functions

1. Medical record auditing.

a. Performs initial charge review to determine appropriate ICD-10 and CPT codes are being used.

b. Interprets medical evaluations, consults, progress notes, other clinical documentation to determine services provided are assigned accurate coding.

c. Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.

d. Monitors and follows up to ensure all services that can be billed are captured and coded for billing.

e. Identify and resolve clinical documentation and charge capture discrepancies to improve quality of the clinical documentation, severity and reimbursement levels assigned, integrity of charges data reported.

f. Remains current with regulatory requirements and new contracts with third-party payers.

g. Recommends changes to Menninger guidelines as needed.

2. Provider education and credentialing.

a. Educates new clinical staff on the correct usage of CPT coding guidelines, including contractual variances with third party payors.

b. Conducts ongoing training sessions as CPT guidelines continue to change.

c. Assures compliance with all health plan requirements as related to the provider certification and credentialing.

d. Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate.

3. Maintains knowledge of information and functionality.

a. Observes all HIPAA required practices including, but not limited to, maintaining HIPAA compliance and confidentiality for all patient and clinic information.

b. Maintains knowledge of computer system functions as it pertains to Patient Accounts.

c. Uses data and information to assist in decision making.

d. Makes recommendations to improve the processing of claims, collections of accounts and statements to clients.

4. Assist with other Accounting projects as assigned and complete other duties as requested.

Accepts additional assignments willingly.

b. Demonstrates an ability to respond to changing workloads.

c. Prepares in a timely and accurate manner all other tasks as assigned.

Education : Associate’s degree in Business or related field preferred.

License/Certification: Completion of an accredited medical coding/billing program.

Experience Required: 2 years of experience in medical/psychiatric billing and collections. Proficient in CPT and ICD10 coding with an understanding of behavioral health language/terminology. Knowledge of Cerner EMR is a plus.