Medical Coding & billing Auditor (Dover)

Job is fully onsite. Must have CPC. Professional Physician coding experience is a must, auditing experience is preferred.

Summary :

Performs data quality reviews on provider records to validate the ICD-10 codes, CPT codes and clinical documentation. Audits provider (physician and midlevel providers) records for accuracy of principal and secondary diagnosis and / or procedures and ensures compliance with all reporting and documentation requirements. Educates providers, coders and charge entry personnel on coding guidelines and documentation requirements. Provides coding support to facility coding and billing staff.

Responsibilities :

1. Audits medical records for accurate CPT coding assignment. Compiles reports with an analysis of findings from the medical record audits. Ensures the selected CPT code supports the clinical documentation contained in patient record. Consistently meets established productivity targets for record audits.

2. Audits all establish provider medical records on by annual basis :

a. Audits medical records for accurate CPT coding assignment.

b. Maintains audit lodge for facility.

c. Compiles reports with an analysis of findings from the medical record audits.

d. Ensures the selected CPT code supports the clinical documentation contained in patient record.

e. Consistently meets established productivity targets for record audits.

3. Medical Staff Relationship :

a. Communicates (verbal / written) with providers to validate observations and suggest additional and / or more specific documentation

b. Designs and implements, in collaboration with the Revenue Cycle Manager specific tools to support medical record physician documentation.

c. Develops and implements plans in coordination with the Revenue Cycle Manager for both formal and informal education of providers.

d. Communicates to participants the benefits of complete clinical documentation.

4. Trains new employees on the facility revenue cycle team on coding and documentation guidelines

5. Assistant Revenue Cycle manager with evaluation of coding activities and the performance evaluation of the revenue cycle personnel as needed.

6. Performs coding procedures as needed and warranted.

7. Develops and implements plans in coordination with the Revenue Cycle Manager for both formal and informal education of providers.

8. All other duties as assigned within the scope and range of job responsibilities.

Required : Associate degree

Certified Professional Coder

Five (5) years in Inpatient / Outpatient coding and auditing experience