Job Summary:  The Medical Coding Auditor protects company assets by completing coding documentation and quality & program audits to ensure support of services billed, complying with all federal and state regulations and internal controls, and recommending improvements in internal control structure. 

Primary Responsibilities (illustrative):

Follows established protocols, selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for compliance with all regulations for federal and state agencies, third-party payers, and organization policy.Communicates audit progress and findings by preparing reports and providing information to the Compliance Officer, CMO, Medical Coding Lead, Compliance Specialist and Chief Quality Officer as needed.In conjunction with appropriate personnel, investigates, evaluates, and identifies opportunities for improvement, recognizes their relative significance in the overall system, and provides guidance to departments regarding internal controls. Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations, and review of current literature. Conducts billing and coding training, including provider training, as they relate to billing, coding, and documentation compliance.Assists with the development and review of policy and procedures and provides necessary staff support and resources to develop and maintain policies to ensure compliance with designated federal and state laws, regulations, and policies. Assists the Compliance Officer in developing and implementing education and training materials related to documentation and coding, as well as regulatory compliance.Supports the Compliance Officer in the review of, and response to, documentation and coding reviews and quality and program audits, compiling information for submission to the QA/QI committee and Board of Directors. Participates in monitoring reviews and audits conducted by various regulatory agencies.Analyzes provider documentation to assure the appropriate Evaluation and Management (E&M) levels are assigned using the correct CPT code. Fields coding questions from clinical and ancillary staff.Other duties as assigned.

Job Requirements:

Knowledge of healthcare compliance regulations.Ability to use Excel spreadsheets and other analytical software.Thorough knowledge of Valley Health EMR system.Effective communication skills – when presenting to individuals and groups and must use appropriate tact when communicating chart audits/documentation concerns with providersAbility to conduct audits.Ability to report research results.Ability to analyze information and conduct statistical analyses.Ability to act with objectivity.Must adhere to all confidentiality policies and procedures in the performance of duties. 

Qualifications:

5+ years of experience in health care Professional Billing Coding certification (CPC, CCS-P) requiredAdvanced knowledge of medical terminology, techniques and surgical procedures; anatomy and physiology; major disease processes.Excellent understanding of HIPAA regulations and issues.

Working Conditions:

 

Work is sedentary in nature; however, the ability to stand and/or walk for short periods of time; stooping, bending, reaching, lifting approximately 10 pounds is required.Work is repetitive in nature and requires concentration and constant technical attention to accuracy and detail for extended periods of time.Conveys a professional and positive image and attitude of regarding the health center and organization.Duties are complex, varied; require planning and coordinating several activities at once. Subject to frequent interruptions.Work is performed in a normal office environment, with travel to all Valley Health clinical sites.