What are the responsibilities and job description for the Medical Coder - Quality Auditing position at AmeriHealth Caritas Health Plan?
Responsibiliites:
The quality auditing medical coder will conduct quality reviews of medical records and supporting documents for claims billed to ACFC. The auditor will conduct audits based off of payment integrity vendor recommendations, provider disputes, and clinical editing criteria applied to claims. Medical record reviews will be used to validate the integrity of the codes billed in relation to the services provided to our members. The comprehensive quality reviews will ensure accuracy and compliance with coding standards and healthcare regulations.
Responsibilities:
- Understand, interpret, and apply coding guidelines for coding quality audits
- Audit electronic medical records to ensure compliance with coding and billing standards
- Audit accuracy of vendor recommendations for cost savings utilizing medical records and supporting documentation
- Review provider disputes within all designated timeframes in relation to coding and medical record submissions. Document all findings and provide detailed responses to vendors, providers, and service area teams
- Ability to identify coding errors, inconsistencies, and abnormal billing patterns.
Education/ Experience:
- 3 to 5 year's experience in medical coding.
- Bachelor’s degree preferred.
- Certified Professional Coder (CPC) required.
- Knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies.
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