Physician Coding Auditor

Position Location : 100% Remote

This is a full-time, remote position that offers a flexible schedule.

Description :

Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoder's internal coding / auditing policies and expectations set forth by department management. Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.

Candidates ideally have recent auditing experience specializing in some of the following profee areas : Ophthalmology, Behavioral Health, Cardiovascular / Cardiothoracic Surgery, Complex ENT Surgery, Dental, Complex Plastic Surgery, Orthopedic Surgery, Peds NICU / PICU, and FQHC / RHC.

Responsibilities :

• Perform professional compliance audits of coding and documentation including surgeries, visits, and other services for multiple provider types across multiple specialties, for multiple clients;
• Accurate application of appropriate coding and documentation guidelines, including ICD-10-CM Guidelines, CPT Coding Guidelines, AHA Coding Clinics, AMA, CMS, Specialty Association / Society guidance, and others, as applicable;
• Accurate selection of CPT codes for services performed;
• Accurate selection and application of modifiers to CPT codes;
• Accurate selection and evaluation of ICD-10-CM diagnosis coding;
• Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;
• Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor-specific policies, if applicable;
• Appropriateness of documentation for split / shared or incident-to services;
• Appropriateness of provider documentation related to Teaching Physician Guidelines, FQHCs, RHCs, and HEDIS, as applicable;
• Accurately score audits utilizing proper scoring methodology;
• Identifies risk areas and provides mitigation strategies and recommendations;
• Provide detailed findings for each service reviewed on customized reports, including supporting documentation;
• Prepare and present audit follow-up education to clients;
• Prepare and present customized education materials based on the unique needs of the client remotely and on-site;
• Communicate with the Physician Audit and Education Manager on issues, trends, and audit timeline task completion;
• Stay current on all coding guidelines (including specialty - specific guidelines), and maintain credentials as necessary;
• Participate in department and education meetings;
• Maintain confidentiality and protect sensitive information;
• Exhibit professional demeanor and communication (written and verbal);
• Other duties as assigned by leadership.

Education / Experience Requirements :

About MedKoder, LLC :

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