Audit Coding Consultant

Audit And Coding Consultant

Under the direction of senior leadership, the Audit and Coding Consultant audits, develops educational materials, educates providers and coders regarding coding / documentation guidelines. Researches regulations on new codes and reviews opportunities for growth. Ensures accuracy and completeness of coding through a rigorous quality review of external and internal documentation of audit process ensuring compliance with federal and state regulations. Responsible for provider and coding training programs.

• Ensure appropriate methodology to include financial controls, identification of trends and unusual patterns, reimbursement deficiencies, and to improve processes. Confirm appropriate services are provided in accordance with examination protocol and medical billing. Work with vendor to ensure audit processes maintain appropriate controls, providing feedback to both vendor and physicians regarding results. Identify unusual examiner patterns based on trends identifiable to the vendor / provider or coder. Identify deficiencies in the reimbursement process and opportunities for appropriate reimbursement. Provide a detailed report listing the findings and any adjustments required to the invoices for all inappropriately invoiced services. Make recommendation for improvements in processes or policies and create / execute provider education for individuals and / or group sessions. Maintain audit results and ensure provider movement throughout the compliance audit plan. Analyze and confirm external results and as appropriate, which with senior leadership and compliance to create action plans.
• Research guidelines and regulations for proposed lines of business. Keep revenue cycle and physicians updated on new or changing regulations. Work with IT to ensure that codes are updated and build for new services include required data points.
• Performs other duties as assigned.
• Bachelor's Degree - Preferred
• Associate's Degree or 2 years' work related experience - Required
• 3 years Revenue Cycle experience - Required
• 3 years Professional Coding experience - Required
• 5 years coding leadership experience or equivalent - Preferred
• Professional coding Auditor certification - Required
• Certified Professional Coder (CPC) Professional coding certification - Required