Coding Auditor/Educator

Job Title

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

Key Functions

• Medical record auditing.
• Performs initial charge review to determine appropriate ICD-10 and CPT codes are being used.
• Interprets medical evaluations, consults, progress notes, other clinical documentation to determine services provided are assigned accurate coding.
• Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.
• Monitors and follows up to ensure all services that can be billed are captured and coded for billing.
• 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.
• Remains current with regulatory requirements and new contracts with third-party payers.
• Recommends changes to Menninger guidelines as needed.
• Provider education and credentialing.
• Educates new clinical staff on the correct usage of CPT coding guidelines, including contractual variances with third party payors.
• Conducts ongoing training sessions as CPT guidelines continue to change.
• Assures compliance with all health plan requirements as related to the provider certification and credentialing.
• Reviews and streamlines processes and workflows for the onboarding department, using automation, where appropriate.
• Maintains knowledge of information and functionality.
• Observes all HIPAA required practices including, but not limited to, maintaining HIPAA compliance and confidentiality for all patient and clinic information.
• Maintains knowledge of computer system functions as it pertains to Patient Accounts.
• Uses data and information to assist in decision making.
• Makes recommendations to improve the processing of claims, collections of accounts and statements to clients.
• Assist with other Accounting projects as assigned and complete other duties as requested.
• Accepts additional assignments willingly.
• Demonstrates an ability to respond to changing workloads.
• 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.