Job Description

Responsibilities

The Coding Auditor is responsible for determining that ICD-10, CPT-4, and HCPCS coding is supported by the clinical documentation in the medical record as well as validating medical necessity per CMS Local Coverage Determination (LCD). Applies working knowledge of medical terminology, anatomy, CPT-4 and ICD-10 codes and coding skills/ experience to ensure timely and accurate audits of clinical documentation as requested. Meets or exceeds established performance targets (productivity and quality) established by the Coding Manager. Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report findings to the Coding Manager. Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured. Provides feedback on audit and education plans and materials and makes recommendations for updates that will enhance the auditing process. Demonstrates the ability to be an effective team player. Upholds “best practices” in day to day processes and work flow standardization to drive maximum efficiencies across the team.

 

  • Performs accurate and timely review of clinical documentation as requested to ensure that ICD-10, CPT-4 and HCPCs coding is supported by the clinical documentation is medical record. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
  • Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report accurate and timely findings to the Coding Manager. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
  • Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured.
  • Provides feedback on audit and education plans and materials and makes recommendations for updates that will enhance the auditing process.
  • Maintains an expanded knowledge base CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies. Meets continued education guidelines to maintain current AAPC CPC certification.
  • Exercises good judgement in escalating identified coding trends that may negatively impact productivity, quality or revenue to enhance clinical documentation to support codes billed, drive consistency across IPM, mitigate claim denials, expedite reprocessing of claims and maximize opportunities to enhance front end, coding-related claim edits to facilitate first pass resolution.
  • Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.
  • Performs other duties as assigned.

Qualifications

Education: High School Graduate/GED required. Technical School/2 Years College/Associates Degree preferred. CPMA Certification

 

Work experience: Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance, coding, auditing or equivalent operations work environment.  AAPC CPC Certification required.

 

Knowledge: Healthcare (professional) billing, CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies. Understanding of the revenue cycle and how the various components work together preferred.

 

Skills: Excellent organization skills, attention to detail, research and problem solving ability. Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.   Service-oriented/customer-centric. Strong computer literacy skills including proficiency in Microsoft Office.

 

Abilities:

 

Equipment Operated: Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable.

 

 

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

 

 

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