Network Practice Coder / Auditor

Network Practice Coder / Auditor

Job Summary : The Coder is responsible for auditing medical records, including applicable diagnoses and operative / diagnostic procedures in patient medical records, using the current International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedures Coding System (HCPCS) and identifying opportunities for improvement as well as assuring compliance with coding and documentation guidelines. In addition the coder is responsible to provide education and training to providers and other agency coders based on the findings of the medical records audits. Does related work as required.

Responsibilities :

• Using the current HCPCS, ICD and CPT coding guidelines, audits medical records for coding for accuracy
• Identifies patterns and opportunities requiring provider education.
• Works with providers and office staff to educate on proper coding and documentation. Identifies service-specific / provider specific trends for education.
• Conducts focused audits on specific services / specialties to identify root causes of coding / denials and provide feedback. Keeps a log of findings and re-reviews to ensure understanding and ongoing correctness. .
• Identifies coding trends for the purpose of education to the coding and physicians and APPs
• Provides education to physicians and APP’s regarding proper documentation to support billing activities
• Keeps abreast of payor rules regarding coding to assist with possible charge transformation rules.
• Reviews edits in Cerner and SSI to identify additional documentation / coding / medical necessity trends for correction and education. Works with Clinisys team to flag possible coding issues.
• Monitors coding E / M levels to identify trends requiring further education
• Monitors coding surgical procedures in practice and hospital settings to identify trends requiring further education.
• Other duties as assigned.

Qualifications / Requirements :

Experience : Three to four years of experience where the primary function of the position was inpatient and outpatient medical records coding and / or auditing in a large multispecialty practice setting, including surgical speacialties is required. HCC Risk adjustment Coding esperience is preferred.

Education : High school or equivalency diploma, required. An Associate's degree or Bachelor's degree in health information management may be substituted for one year of the required experience.

Licenses / Certifications : Current certification as either a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician Based (CCS-P) through AHIMA, or as a Certified Professional Coder (CPC) through the American Academy of Professional Coders.

Other : Thorough knowledge of the current HCPCS, CPT and ICD codes; thorough knowledge of medical terminology; thorough knowledge of the principles of the medical record system and its operation; ability to understand and code medical records; ability to communicate effectively both orally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; thoroughness; sound judgment; tact; discretion; initiative; accuracy; physical condition commensurate with the demands of the position.

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