Medical Coding Auditor
Overview
SCALE Compliance and Risk Management is currently seeking an experienced Medical Coding Auditor with a background in multi-specialty Physician Professional Fee coding and auditing. The Auditor must understand medical terminology, coding, and various payment methodologies as well as possess strong time management skills and feel confident working independently with a high level of attention to detail. This position is fully remote.
Primary Responsibilities
- Performs regularly scheduled audits and reviews on a variety of professional fee record types including Evaluation and Management, surgical CPT, inpatient & outpatient professional fees for a variety of specialties including nephrology, cardiology, GI, and internal medicine, focusing on the accuracy of physician code selection.
- Verifies the accuracy and completeness of ICD-10-CM, CPT-4, and HCPCS coding, and reviews modifiers, units, and other variables, as well as identifies & records discrepancies, and the logic for changes in coding decisions.
- Analyzes patient records to identify non-conformances in CPT and ICD-10-CM code assignment and provide detailed rationale & supporting evidence for findings and offer recommendations for improvement.
- Determines providers are sufficiently capturing services provided to patients.
- Assist in the preparation of reports of findings of coding and documentation audits.
- Provides executive summary on coding issues and findings to various clients.
- Maintains knowledge of current and updated coding guidelines, third party payer requirements, government regulations and all applicable coding/billing policies and procedures.
Qualifications
- Bachelor’s Degree required
- 5-10 years coding experience at an executive level in the healthcare space required.
- Prior experience with incorporating audit findings in an executive summary report, highlighting corrective actions and recommendations required.
- Experience working with raw data sets
- In-house coding audits and be the point person for larger projects outsourced to third parties
- Current certification from either AHIMA (CCS, CCS-P, RHIA, RHIT) or AAPC (CPC or COC with CCC, CCVTC) & required maintenance of credentials through continued education
- Strong knowledge of ICD10-CM, CPT (surgical, other procedures, and E/M), and HCPCS coding systems, medical terminology, A&P
- Must be proficient in CMS 1995 and 1997 E/M documentation guidelines
- Proficient in Microsoft Excel
- High degree of comfort working within EMR systems (eClinicalWorks and EPIC preferred)
About Us
SCALE is an entirely unique management consulting firm that offers a full range of multidisciplinary solutions exclusively to healthcare service organizations including provider platforms, pharma business services, diagnostic labs, hospital systems, and healthcare focused private equity groups. Our multidisciplinary team of experts bring an average of 25 years of senior healthcare management and operational discipline experience to our engagements, providing tailored solutions that help physician groups grow and thrive in today’s marketplace.
