Coding Auditor

Job Summary

The Coding Auditor is responsible for implementing a comprehensive audit protocol to audit and determine the integrity of coding and billing processes, detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed for physician and clinic fees. In addition, Coding Auditor will research current federal (CMS), state Local Coverage Determinations and fiscal intermediaries (First Coast/Palmetto) to further educate physicians, providers, and staff regarding the updates on billing and coding to ensure compliance.

Reporting directly to the General Counsel & Compliance Officer, this role in enterprise-wide and will have regular interaction with all departments, providers, and relevant staff.

ESSENTIAL JOB FUNCTIONS (other Duties As Required)

• Build a regular, consistent audit protocol and process across all employed and/or contracted providers.
• Develop and execute provider comprehensive educational opportunities/curriculums, coding resources, materials, webinars, campaigns, etc.
• Leads provider education events to discuss overall audit results, note trends and changes within coding compliance and regulatory guidelines.
• Provides support or project management for any other related audit and coding initiatives and assist in other related responsibilities as required by executive leadership team.
• Participates in the development, implementation, and ongoing compliance monitoring of the Compliance Plan.
• Maintains current knowledge of applicable federal and state regulations, bulletins, and code changes as well as updates from fiscal intermediaries.
• Serves as billing/coding resource to the organization regarding compliant billing practices.
• Adherence to applicable laws, regulations, and contractual obligations. Follows the principles of the Compliance Program as well as the US Eye Code of Conduct.
  
  
  

Competencies

Business and Industry Acumen

• Strong knowledge of E&M regulations and CMS documentation guidelines.
• Successful experience with data abstraction to analyze patient encounters for focused review, sample and development of coding education materials and resources.
• Proficient in ICD10CM, CPT and HCPCS coding, policy and procedures based on physician practices.
• Demonstrates general understanding of the business, industry, and organization.
• Demonstrates ability to redirect issues to appropriate resources.
  
  
  

Personal Effectiveness and Credibility

• Communicates verbally and in writing effectively with staff and providers.
• Demonstrates strong research and data interpretation skills/secondary research resources (i.e., Internet).
• Maintains appropriate degree of confidentiality.
• Demonstrates interpersonal skills.
• Demonstrates a strong self-initiative and self-motivation.
• Demonstrates effective time, organizational and prioritization skills.
• Demonstrates team skills and respects differences.
• Demonstrates presentation and writing skills.
• Comfortable working independently with little or no supervision.
• Demonstrated organization, facilitation, written and oral communication, and presentation skills.
  
  
  

Education And Experience

• High School degree or GED
• Prior Physician Coding & Auditing experience or prior Revenue Cycle/billing experience related to Coding.
• At least 2 years of professional E&M coding experience and 2 years of E&M provider education experience.
• Expert Licenses & Certifications: AAPC Certified Professional Coder, AAPC Certified Professional Medical Auditor, AHIMA Certified Coding Specialist-Physician-based.
• Upon Hire, CPC-Certified Professional Coder and/or CCS-P-Certified Coding Specialist-Physician required.
• CPMA-Certified Professional Medical Auditor must be completed within 1 year.
  
  
  

Supervisory Responsibilities

The position has no supervisory responsibilities. CODING AUDITOR JOB DESCRIPTION

Position Type And Expected Hours Of Work

• This is a full-time, hybrid position.
  
  
  

Physical Demands

• Prolonged periods of sitting at a desk and working on a computer.
  
  
  

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Benefits

401(K) Company Match

Medical and Dental Insurance

Vision Benefits

Flexible Spending Accounts

Pet Insurance

Disability Insurance

Life Insurance

Continuing Education

Paid Time Off

US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.