Outpatient Coding Auditor

Outpatient Coding Auditor #1049 – Remote

  • Status: Full-time

Job Description

The Outpatient Hospital Coding Compliance Auditor will provide expert auditing services across various hospitals for Outpatient coding services. Outpatient Coding Compliance Auditor will have a thorough knowledge of Acute Care facility Federal and State reporting guidelines, CPT/HCPCS coding, UB-04 Revenue coding, modifiers, sequencing rules and the National Correct Coding Initiative (NCCI) edits, AHA Coding Clinic, Official Guidelines for Coding and Reporting for ICD-10-CM coding conventions.

This candidate should have extensive knowledge and experience in Evaluation and Management (E/M) auditing, physician documentation improvement education, and the interpretation of regulatory compliance for third party payers. This individual serves as a dedicated team member who consistently demonstrates integrity and a strong client-oriented work ethic within the coding audit environment.

The candidate will be required to demonstrate the ability to manage time, have critical/creative thinking, must have strong communication and problem-solving skills. They will demonstrate the ability to manage large caseloads and effectively work in a fast-paced environment.

This individual will provide education to coders on audit results, utilize expertise to research and respond to challenging coding questions, develop and provide coding education and evaluate audit results to recommend corrective actions. Candidate must have the ability to provide education, training either written, in person or through team webinar trainings to coders and/or client physicians when requested or as needed.

This candidate will collaborate with auditing team and manager to ensure continuity and coherence in application of policies and procedures.

Primary Responsibilities:

  • Perform coding compliance and quality audits in support of our compliance program and client expectations Analyze and interpret documentation from medical records
  • Clearly document audit findings and calculate billing error rates Provide feedback and education as appropriate depending on findings
  • Articulate audit findings appropriate for audience. Prepare written audit reports as needed summarizing audit findings and any corrective action necessary to mitigate risk
  • Work with HIM coding management in developing education and training for coders, clinical department and/or physicians for documentation improvement
  • Conduct ad hoc coding and billing audits as requested
  • Audit according to productivity performance standards and goals set by department
  • Educate and audit coders and auditors as well as audit and educate new coders
  • Stay abreast of relevant LCDs, NCDs, billing and coding guidelines concerning the current areas of audit focus
  • Manage ongoing audits resulting from external denials (RAC, FMQAI and other recovery company) and appeals when necessary

Required Qualifications:

  • Associate’s Degree or higher in related concentration such as Health Information Management or Health Information Technology or equivalent experience
  • 8+ years coding experience
  • 3+ years of audit experience
  • Proficient in application of acute hospital coding guidelines, policies, processes and practices
  • Must maintain active coding credential by obtaining qualifying CEUs as needed
  • Extensive, current knowledge of acute hospital coding rules, official coding guidelines and policies
  • Exceptional technical skills in most software applications such as Excel, Word and Outlook
  • Highly experienced and comfortable in most Electronic Medical Records and encoder / grouper products
  • Comfortable and very experienced in leading remote education and training sessions to a group or individuals while using WebEx and other similar applications

Preferred Qualifications:

  • Experience with computer assisted coding (CAC) products


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