Summary
The job is for a Physician Coding Auditor who will perform coding and compliance audits remotely. The position requires extensive knowledge of professional coding and auditing, a high school diploma or associate degree, at least 5 years of physician coding experience, 3 years of auditing experience, AAPC CPMA credential, and additional skills such as Microsoft Office proficiency, time management skills, research and report writing skills. The job offers health, vision, and dental insurance coverage, life insurance, flexible work schedules, vacation days, holidays, professional development opportunities, 401K and profit sharing, short-term disability, long-term disability, life insurance, FSA program, AAPC and AHIMA corporate memberships.
Requirements
- A minimum of a high-school diploma, Associate Degree preferred
- Successful completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential (CCS, CPC, etc.) required
- Successful completion of the AAPC CPMA credential required; preferably a combination of two or more credentials
- Minimum 5 years of physician coding experience and 3 years auditing experience required
- Must be a subject matter expert on E/M and Surgical coding
- Must have expert knowledge of medical terminology, CPT and/or ICD-10 coding, and Medicare and Medicaid billing policies for professional services
Responsibilities
- Performing audits of coding and documentation compliance audits of surgeries, visits, and other services for providers, including physicians and mid-level providers across multiple specialties
- Accurate application of appropriate coding and documentation guidelines
- Accurate selection of CPT codes for services performed
- Accurate 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’s documentation related to Teaching Physician Guidelines, PQRS, FQHC, and RHC's as applicable
- Use scoring methodology to accurately score audits
- Provide detailed findings for each service reviewed on an excel spreadsheet or other customized report, including supporting documentation
- Prepare and present customized education materials based on the unique needs of the client remotely and on-site
- Communicate with Coding Team Lead on audit timeline task completion
Preferred Qualifications
- Experience with Microsoft Word, Excel, PowerPoint, Windows, and healthcare information and billing systems
- Experience working independently
- Excellent time management skills
- Ability to switch between multiple projects
- Ability to meet project deadlines
Benefits
- We pay up to 100% of your health, vision, and dental premiums for you!
- FREE Group-Life Policy for full-time employees
- All positions are permanent – no contracts or sitting on a “coding bench”
- Internal Network of Medical Coding Industry Leaders
- President/CEO is a Certified Coder with 20+ years
- Fantastic time off package! Full-time employees accrue 12 vacation days and have 8 paid holidays per year without any long-term waiting periods
- Flexible work schedules, year-round!!
- Privately held, growing company with strong values and ethics
- Employees are provided professional development and education which includes 30 hours of CEU pay per year
- 401K and Profit Sharing
- STD, LTD, Life insurance, and FSA Program
- Employer Paid AAPC and AHIMA Corporate Memberships
