Job description
Job Summary:
The Coding Auditor provides professional services auditing including training, consultation, audit and feedback to clinicians on their documentation and coding to ensure Emanate Health Medical Group receives appropriate reimbursement and conforms to applicable guidelines and regulations. Advocates compliance with all third party billing and reimbursement requirements including, but not limited to, the requirements of Medicare and Medicaid programs. Serves as the coding subject matter expert for the physicians. Specific to Family Medicine and Pediatrics. Must have HEDIS and HCC Knowledge and understanding
Job Duties:
1. Performs regularly scheduled audits of professional fee coding and documentation of providers. Verifies the accuracy and completeness of ICD-9-CM. ICD-10-CM, CPT-4, and HCPCS coding; reviews modifiers, units, and other variables impacting workload accountability and billing. Determines providers are sufficiently capturing services rendered to patients; assesses compliance with Medicare, Medicaid and other third party requirements for coding and billing. Re-codes encounters from source documentation when errors are identified; completes supporting worksheets documenting rationale for coding decisions and compares findings against those generated from the provider; identifies and records discrepancies and the logic for changes in coding decisions.
2. Provides specialty-specific training to clinicians on documentation of services and appropriate coding of level of service (E/M), diagnoses (ICD-9 and 10 CM), procedures (CPT and HCPCS) coding. Analyzes audit data compiling reports and provides summary feedback to individual clinicians, making recommendations for improvement. Develops training materials and documents information derived from audit findings for feedback to physicians and other audit staff.
3. Monitors usage of CPT and ICD-10 codes by physician including in-depth analysis of patterns, volume of services, peer comparison and trending. Educates physicians and associates providing expertise on proper coding and billing practices to achieve optimal reimbursement for services performed.
4. Provides input in the development, refinement, and implementation of methods and procedures used to complete audit functions. Collaborates with physician specialties to develop and implement strategies to make appropriate documentation and coding easier for clinicians.
5. Maintains knowledge of current and updated coding guidelines, third party payer requirements, government regulations and all applicable coding/billing policies and procedures. Ensures that Emanate Health Medical Group coding and documentation meets regulatory guidelines and audit standards that result in appropriate reimbursements. Maintains competency in professional services coding and documentation requirements.
6. Adheres to all Emanate Health Medical group standards, policies, and procedures.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
- Monday to Friday
Ability to commute/relocate:
- Covina, CA: Reliably commute or planning to relocate before starting work (Required)
Experience:
- ICD-10: 1 year (Preferred)
Work Location: One location
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