Coding Auditor Job Description

Coding Auditor Job Description

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Coding auditor provides education to internal staff and external providers based on audit findings; provides general education on ICD-9 and ICD-10 codes as appropriate.

Coding Auditor Duties & Responsibilities

To write an effective coding auditor job description, begin by listing detailed duties, responsibilities and expectations. We have included coding auditor job description templates that you can modify and use.

Sample responsibilities for this position include:

Performs coding compliance audits on E&M visits/encounters in all settings/sites (professional and technical), and/or CPT coded services performed by clinical institutes and/or physicians, using criteria based on official CPT and ICD-9 guidelines and other applicable regulations
Performs inpatient coding audits using ICD-9-CM, ICD-10-CM/PCS, DRG validation (3Mcoding software) utilizing appropriate coding references for CHS hospitals via scanned, electronic and hybrid medical records
Performs centralized outpatient coding audits of scanned or copied medical records and abstracts using ICD-9-CM and CPT (3M coding software) and appropriate coding references, for CHS hospitals and CCS coding staff
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding
Develop and conduct ongoing coding training to include but not limited to ICD-9, ICD-10-CM and Medicare Risk Adjustment coding to new associates, training for existing staff as needed
Attend the Compliance Committee meetings
Provide other services as needed to assist in effective operations of the compliance program
Work with CHKS clients both in the NHS and private sector by undertaking regular complex audits of clinically coded data to assess coding quality for accuracy, completeness, consistency and timeliness
To support clients in the development of audit programmes to ensure ongoing improvements in their quality assurance for both the organisation and their commissioners
Have a pro-active and positive approach when working with clients to identify areas where further work may be required, for example training or more specialised audit

Coding Auditor Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Coding Auditor

List any licenses or certifications required by the position: RHIT, RHIA, CCS, AHIMA, CPC, AAPC, COC, CIRCC, CIC, CRC

Education for Coding Auditor

Typically a job would require a certain level of education.

Employers hiring for the coding auditor job most commonly would prefer for their future employee to have a relevant degree such as Associate and High School Degree in Education, Associates, Health Information Management, Technical, Health, Business, Healthcare, Management, Health Information Technology, Medical

Skills for Coding Auditor

Desired skills for coding auditor include:

Medical terminology
Excel
CPT
Word
ICD-10
Microsoft Word
Anatomy and physiology
PowerPoint
Requirements and guidance in the performance of audit duties

Desired experience for coding auditor includes:

Undertake reviews within NHS Mental Health Trusts
Performs coding quality reviews in collaboration with or for internal divisions of the organization
Reviews, researches, and processes billing edits working collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately
Demonstrated ability to review analytical, data and audit findings to identify coding trends and risk areas
Ability to develop data requirements and work with Compliance Analyst and other analytical groups to extract, organize and analyze coded data
Demonstrated ability to work independently with minimal supervision, including willingness to be flexible depending upon department and/or physician schedule needs

Coding Auditor Examples

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Coding Auditor Job Description

Job Description Example
Our company is hiring for a coding auditor. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for coding auditor
  • Follows the Official ICD-9/ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines
  • Ensure that all ICD-9/ICD-10 diagnoses are reported in accordance with CMS payment and Risk Adjustment guidelines
  • Will utilize hospital abstracting system for coding validation when applicable
  • Prepares preliminary results for review by the requesting party
  • Reviews DRG change disagreements with the Director of Coding Audits & Denials Management
  • Assists in preparation of the final quarterly audit reports for Division VP’s, AVP’s, facility CEO’s, CFO’s, Regional HIM Director’s, VP of HIIM
  • Provides coder education via email and phone on all audits and uses applicable coding references
  • Maintains productivity levels set forth by the HIIM Department and interdepartmental policy while maintaining a 97% accuracy rate by third party auditors
  • Consults with Director of Coding Audits & Denials Management during any audit discrepancies
  • Attends coding workshops as necessary to maintain coding credentials
Qualifications for coding auditor
  • Requires the ability to sit and be stationary for prolonged periods of time
  • May be required to travel to off-site hospitals
  • Demonstrated ability to constructively and sensitively provide feedback to physicians and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas
  • Audit skills and the ability to interpret and apply Federal and State regulations, coding and billing requirements
  • Ability to work with and maintain confidentiality of physician, patient, patient account, and personnel data
  • Bachelor's degree in finance/business, medical records technology, health services administration, nursing or other ancillary medical area OR four (4) years of experience in a directly related field
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Coding Auditor Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of coding auditor. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for coding auditor
  • Providing a comprehensive assessment and evaluating for all co-morbidities that would be expected based on the patients history
  • Clinical documentation accurately reflects co-morbidities presented by a patient
  • Claims are accurately coded to reflect all co-morbidities documented in the patient record
  • Working directly with the ACO physician practice to ensure that all patients, attributed to a practice, with a history of a comorbid or chronic conditions are scheduled for at least an annual well visit for the reassessment of such condition
  • This position will require local travel within the AHS system to physician offices
  • Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge disposition
  • Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition
  • Develop competencies and quality assessment tools for education/compliance requirements
  • Identify areas for documentation improvement and provide feedback to management and administration
  • Serve as Epic superuser and recommend system modifications to improve the organization’s coding functions
Qualifications for coding auditor
  • 1.8 Review medical record documentation so that coding substantiates appropriate reimbursement of accounts receivables
  • 1.12 Coordinate completion of billing reminders to ensure timely resolution of coding/billing issues
  • Must have prior accreditation/credentialing (CPC, CPC-A, CCS-P)
  • Highly knowledgeable and experienced in the areas of ICD - 10 - CM and PCS, CPT and HCPCS coding systems
  • Must possess and maintain certification as a Certified Coding Specialist-Physician-based (CCS-P) from the American Health Information Management Association (AHIMA) or a Certified Professional Coder (CPC) from the AAPC
  • 2 years minimum of medical chart review experience is required
3

Coding Auditor Job Description

Job Description Example
Our company is hiring for a coding auditor. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for coding auditor
  • Maintains coding knowledge and billing regulations associated with DRGs, CPT coding, ICD diagnosis and procedures coding and changes in CMS regulations
  • Conduct internal audits to determine if the organization is complying with its policies and procedures, statutory and regulatory requirements, and contractual obligations
  • Determine scope, objectives, approach, and time budget of audits
  • Identify areas for improvement, risks and how they impact the organization, and lost revenue opportunities
  • Prepare cohesive written reports documenting audit objectives, scope and procedures in addition to findings and recommendations, comparisons, impact, risks, and/or projections
  • Communicate audit results and recommendations to management in a clear and concise manner
  • Follow up on open audit issues and manage action plans with supervisor to ensure timely closure and remediation of identified weaknesses relating to internal controls
  • Assist with development and maintenance of compliance policies, forms., notices, and associated materials to reflect organizational processes compliance with applicable laws and regulations
  • Performs EMR and Chart order audits for medical and radiation oncology
  • Prepares spreadsheet with findings and reports to compliance Director
Qualifications for coding auditor
  • A minimum of three years progressive lead or supervisory experience in a Health Information Management Department in a hospital-based acute care facility is required
  • CPC, CPC-H or CPMA Certification at time of hire
  • 3-5 years clinical coding experience (ICD-9, CPT-4, and HCPCS) or combination of applicable experience and education
  • Extreme attention to detail with ability to prioritize assignments to meet deadlines
  • Medical Coder certification from accredited source
  • CEMC and/or CPMA as a Certified Professional Medical Auditor (CPMA) by the American Academy of Professional Coders (AAPC), CPC (Certified Professional Coder, CCS-P (Certified Coding Specialty), RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician)
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Coding Auditor Job Description

Job Description Example
Our innovative and growing company is looking for a coding auditor. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for coding auditor
  • Participate in provider education activities
  • Consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy
  • Actively participate in internal / external meetings, training activities
  • Provide feedback and trending to leaders
  • Facilitate provider education training, on-line or in person
  • Participate in special projects and other activities associated with the Risk Adjustment program as needed
  • Mastery of Optum coding guidelines, applications and practices
  • Maintain excellent intradepartmental communication
  • Responsible for the daily operation of the Training and Auditing function and staff including monitoring the quality and quantity of workflow to ensure the completion of work assignments
  • Provide cost effective management of resources for the Training and Auditing team
Qualifications for coding auditor
  • Minimum of 5 years of experience comparable to that of a Compliance Auditor and demonstrated competency in knowledge, interpretation and application of documentation, coding and billing rules or medical defense strategies sufficient to carry out the duties and responsibilities of a Compliance Auditor, including but not limited to meeting standards related to audit productivity, audit accuracy rate, timeliness of assignments, education/presentation competencies, and professionalism
  • High school diploma is required, relevant college education preferred
  • CPMA or equivalent experience required
  • Minimum of two (2) years auditing experience and a minimum of three (3) years experience in physician billing, preferably in a multi-specialty physician group, required
  • In depth knowledge of third party reimbursement policies and procedures and a minimum of five (5) years experience in the healthcare industry required
  • Knowledge of data collection methods and statistical reporting, Health Information Management theory, principles, practices, techniques, concepts, and policies required
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Coding Auditor Job Description

Job Description Example
Our growing company is looking for a coding auditor. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for coding auditor
  • Creates/updates and/or maintains charge protocol manuals for each service area reviewed
  • Reviews claims to ensure correct codes for patients accounts
  • Responsible for evaluating and auditing physician and hospital medical records and medical assessment forms to ensure compliance with federal guidelines and medical documentation requirements
  • Must be a CPC
  • Ability to review a minimum of 15 records per day
  • Adherence to Health Information Management (HIM) Coding policies
  • Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy
  • Participates in performance improvement initiatives as assigned
  • Establishes and implements orientation for all members of the AHN audit compliance team
  • Conducts educational sessions for hospital/physician staff
Qualifications for coding auditor
  • Demonstrated high degree of accuracy in auditing and statistical analysis
  • Knowledge of legal and regulatory requirements of medical records required
  • Ability to read medical records to find and resolve documentation discrepancies required
  • Competency with computer spreadsheet applications and database software required
  • Associate’s Degree in a healthcare related program
  • Any AHIMA or AAPC recognized coding credential

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