Coding Auditor Resume Samples
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Coding Auditor Resume Samples
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NH
N Harris
Nickolas
Harris
157 Jones Mall
Chicago
IL
+1 (555) 615 3817
157 Jones Mall
Chicago
IL
Phone
p
+1 (555) 615 3817
Experience
Experience
Boston, MA
Coding Auditor
Boston, MA
Lowe-Lueilwitz
Boston, MA
Coding Auditor
- Assists in developing and maintaining policies and procedures for coding and coding guidelines.Performs other duties as assigned
- Assists in hiring and training new coders and provides input in performance evaluations
- Performs coding quality reviews, provides feedback to coders, and educates coders
- Assists the Physician Auditor Coordinator with developing a detailed audit plan for area being reviewed
- Provides feedback and education to healthcare providers and coding staff through written and personal communication
- Performs Coder Compliance Auditor responsibilities for sections in the central Medical Records department and/or satellite departments
- Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA)
Los Angeles, CA
DRG Coding Auditor
Los Angeles, CA
Turner, Greenfelder and Blanda
Los Angeles, CA
DRG Coding Auditor
- Develops and implements education of physician, nursing, and other clinical staff to improve documentation to yield better coding
- Escalates facility issues to manager for resolution
- Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data - POA, Discharge Disposition
- Works independently in remote locations
- Develops and coordinates educational and training programs regarding technical coding and clinical topics for the coding staff
- Performs reviews in a timely manner to maintain DNFB target of 5 days
- Works with coders and CDS's to draft and initiate physician queries
present
Boston, MA
Inpatient Coding Auditor
Boston, MA
Stracke and Sons
present
Boston, MA
Inpatient Coding Auditor
present
- Identify Coding Quality Improvement opportunities and work with compliance managers and others to develop recommendations
- Performs quality reviews on coding and DRG assignments for inpatient records
- Has the knowledge to perform document control functions
- Assist client organization with internal or external Compliance reviews
- Audit and educate new and established coders and auditors
- Perform coding compliance and quality audits in support of Optum360's Compliance Program and client expectations
- Authors, edits, and reviews quality communications (e.g., policies, procedures, and training) and makes recommendations for updates
Education
Education
Bachelor’s Degree in Health Administration
Bachelor’s Degree in Health Administration
Ball State University
Bachelor’s Degree in Health Administration
Skills
Skills
- Thorough/detailed knowledge of ICD-10 and CPT coding systems
- Excellent written and verbal communications skills
- Provides technical expertise and leadership on coding and coding related issues through multiple mechanisms, participate in project teams dealing with coding and quality data issue
- Ensure compliance with all State, Federal, professional regulations as well as department rules, policies, and procedural manuals
- Assists the Physician Auditor Coordinator with developing a detailed audit plan for area being reviewed
- Conducts coding, billing, and documentation compliance audits within established timeframe and in accordance with the standards defined by Children's Healthcare of Atlanta
- Maintains current knowledge of federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG compliance standards
- Compiles and analyzes administrative and health statistics for reimbursement, quality assurance using manual or computerized methods as appropriate. Complies and generates Core reports and Pull list
- Computer knowledge of MS Office
- Proficient in Microsoft Office, including Word and Excel
15 Coding Auditor resume templates
Read our complete resume writing guides
1
Outpatient Coding Auditor Resume Examples & Samples
- Performs Outpatient reviews
- Utilizes encoders and various coding resources
- Conducts peer reviews to ensure compliance with coding guidelines and provides reports to manager /leader as directed
- Maintains strict patient and physician confidentiality and follows all federal, state and hospital guidelines for release of information
- Maintains current working knowledge of ICD-9 coding principles, CPT Coding principles, government regulation, protocols
- Ability to travel 10% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs
- 3-5 years outpatient coding experience
- Coding certififcation/CCS, CPC, CPC-H, RHIT or RHIA
- Current Work at Home
2
Coding Auditor Resume Examples & Samples
- CPC AAPC Certification required
- Must maintain annual continuing education requirements and remain in good standing with the certification governing body
- Analytical, organizational and time management skills
- Must be willing to work overtime
- One to three years of coding experience and ICD-9 knowledge
- Professional demeanor and appearance, strong work ethic, reliable, resourceful, enthusiastic, team player with positive attitude
- Proficient in the use of Microsoft Office(Word, Excel, Access)
3
Compliance Coding Auditor Resume Examples & Samples
- Medical Coding certification
- Knowledge in the use of specialized references, such as the ICD-9/ICD-10 and CPT books
- 2+ years of provider Coding / Billing and Auditing experience
4
Remote Medical Coding Auditor Resume Examples & Samples
- Performs inpatient, ambulatory surgery, emergency room, outpatient and evaluation/management coding audits on coding colleague work
- May be required to mentor new colleagues
- Utilizes various coding books, procedure manuals and on-line encoders as a resource
- Maintains strict patient, physician, hospital and colleague confidentiality and follows all federal, state and hospital guidelines for release of information
- Maintains current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing
- Supports Precyse's Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when there is a compliance concern or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient information
- 2+ years of coding and auditing experience including inpatient and outpatient coding skills as well as ambulatory surgery, APC, emergency room, evaluation and management, auditing, report-writing expertise, required
- Ability to consistently code at 95% or better accuracy and quality
- Knowledge of medical terminology, ICD-9-CM and CPT-4 codes
- Computer knowledge of MS Office
- Ability to write reports with management review
- Coding skills: prospective payment methodologies, Charge description master review, physician office billing
5
SIU Medical Coding Auditor Resume Examples & Samples
- Audits, assesses, identifies, reviews, and monitors providers, suppliers, and pharmacies to include but not limited to physicians, inpatient, outpatient, ancillary, behavioral health care, laboratory, etc. medical records, and independently codes, abstracts and analyzes inpatient and outpatient medical records using most current International Classification of Diseases (ICD-9/ICD-10), Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes, according to federal, CMS, and state statutory, regulatory and contractual requirements, AMA guidelines, and generally accepted coding practices
- Verifies and validates authorization of services, written clinical documentation of services received through health services and health utilization management departments, and information contained in the health care claim systems against claims, medical records and other documentation submitted by the provider, and identifies coding errors, inconsistencies, anomalies, abnormal billing patterns, and other indicators (e.g., services not rendered, up-coding, un-bundling, etc.) of suspected fraud and abuse
- Coordinates individual work activities with SIU investigators, develops and presents findings and recommendations regarding the appropriateness of diagnosis and procedure codes submitted on provider service claims, and supports overpayment recovery during discussions with medical and behavioral health care providers
- Manages large caseloads involving audits of statistically valid random samples of claims and completes a review findings spreadsheet and summary for the investigative case file and updates system entries with review findings. Communicates complex results of audit findings in meetings and/or judicial hearings
- Educates providers, suppliers, and pharmacies and administrative support staff at all levels on CMS, federal and state statutory, regulatory and contractual requirements, appropriate coding according to AMA guidelines, acceptable practice standards, and procedures for preventing and reporting potential fraud and abuse
- Coordinates coding and payment issues with other areas and departments as required. Supports and participates in process and quality improvement initiatives
- Presents educational seminars on fraud and abuse awareness, detection and reporting to areas and departments as required
- Present findings and provide testimony in legal proceedings as required
- Preferred A Bachelor's Degree in a related field
- Required 3+ years of experience in Healthcare coding directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing, or health care quality improvement is required
- Preferred knowledge and experience working in the government sector of the managed health care industry
- Strong organizational, interpersonal, communications skills
- Efficiently manages multiple priorities, is inquisitive, energetic, and takes initiative
- Intermediate proficiency with ICD-10 coding
- Required Other 3+ years as a Certified Coding Specialist (CCS), Certified Coding Specialist Provider-based (CCS-P), Certified Professional Coder (CPC or CPC-H), or equivalent certification is required
- Preferred Certified Professional Medical Auditor (CPMA)
- Preferred Licensed Practical Nurse (LPN)
- Required Intermediate Microsoft Excel Knowledge of Microsoft Office including Outlook, Word, Excel, PowerPoint, Access and Visio
6
SIU Medical Coding Auditor Resume Examples & Samples
- Preferred Other Knowledge and experience working in the government sector of the managed health care industry
- Intermediate Other Strong organizational, interpersonal, communications skills
- Intermediate Other Efficiently manages multiple priorities, is inquisitive, energetic, and takes initiative
- Intermediate Other ICD-10 proficient
- Advanced oral and written communication skills
- Knowledge of Behavioral Health Inpatient and Outpatient coding
- Preferred Other Certified Professional Medical Auditor (CPMA)
7
Outpatient Coding Auditor Resume Examples & Samples
- Responds to audit rebuttals, provides feedback on audit findings, ramps up new auditors and reports to managers auditing findings to include suggestions for follow up education as needed
- Analyzes data to Identify, document, communicate and report on coding quality of Optum360 coders and or auditors or client coders and report any compliance concerns and offers suggestions for remediation
- Identify Coding Quality Improvement opportunities and work with compliance managers and others to develop recommendations
- HS Diploma or GED
- Coding credential required from AHIMA/AAPC ( RHIT, RHIA, CPC, CCS,CCS-P, COC)
- 3+ years of Outpatient coding experience (Emergency Department, Hospital outpatient surgery, Ancillary, Radiology, Observation)
- 1+ year of Outpatient auditing / training experience
- Familiar with multiple Electronic Medical Record systems
- Demonstrated understanding of the revenue cycle as it relates to coding, auditing & billing (front end to back end)
- Demonstrated ability to use a PC in a Windows environment, including MS Word and Excel
- Experience working with and educating adults; to include remote training
- Additional coding credentials or clinical credentials
8
Coding Auditor & Training Resume Examples & Samples
- Bachelor's degree preferred or equivalent experience required
- 5 years' of related work experience
- Must have CPC or CCS-P, Certification of Healthcare Compliance (CHC) strongly preferred
- Advanced experience utilizing Microsoft Excel: Including Pivot tables. Beginner/Intermediate experience with Microsoft Access
- Experience should include thorough knowledge of health care operations, physician practice reimbursement including RVUs, charging practices, governmental coding requirements including extensive knowledge of CPT / HCPCS / ICD and modifiers, and healthcare financial systems
- Experience with researching, interpreting and applying Medicare, Medicaid, MASSHEALTH, and other third party payer regulations is essential
- Superior analytical skills, excellent writing, organizational and interpersonal skills, to communicate information effectively and to work with the vast array of information gathered, its analysis, and delivery to the requesting management team
- Demonstrated highly developed project management skills, along with excellent problem solving and analytical skills, and verbal and written communication skills
9
Coding Auditor & Trainer Resume Examples & Samples
- Must have CPC or CCS-P, Certification of healthcare compliance (CHC) strongly preferred
- Advanced experience utilizing Microsoft Excel: Including Pivot tables. Beginner/Intermediate experience with Microsoft Access
- Experience should include thorough knowledge of health care operations, physician practice reimbursement including RVUs, charging practices, governmental coding requirements including extensive knowledge of CPT / HCPCS / ICD and modifiers, and healthcare financial systems
- Experience in researching, interpreting and applying Medicare, Medicaid, MASSHEALTH, and other third party payer regulations is essential
- Superior analytical skills, excellent writing, organizational and interpersonal skills, to communicate information effectively and to work with the vast array of information gathered, its analysis, and delivery to the requesting management team
- Demonstrated highly developed project management skills, along with excellent problem solving and analytical skills, and verbal and written communication skills
10
Coding Auditor Resume Examples & Samples
- 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. Investigates, gathers, interprets and applies coding guidelines and billing regulations as supporting documentation for audit results
- Complies with Standards for Ethical Coding
- Prepares detailed reports that include analysis of findings, identification of issues and provides recommendations to the clinical institute management and/or coding staff
- Provides feedback and education to healthcare providers and coding staff through written and personal communication
- Minimum of four years CPT/ICD9 professional coding experience
- Additional technical/facility coding additional experience is desirable
- Experience in auditing principles and practices is preferred
- Requires working knowledge of human anatomy and physiology, attained through related education and experience in disease processes and medical terminology
- Demonstrated knowledge of accurate application of current CPT4 and ICD9-CM coding principles for both professional and technical/facility settings
- Knowledge of applicable state and federal regulations concerning medical record documentation, coding and billing practices
- Computer literacy required
- Must be proficient with Excel and Word
- Prior audit experience with Intellicode and 3M Encoder software preferred
11
Clinical Coding Auditor Resume Examples & Samples
- HSCIC Registered Clinical Coding Auditor
- ACC – Accredited Clinical Coder
- Experience of delivering IG and other coding audits to high quality and tight deadlines
- Good knowledge of national payment tariff , HRGs and the impact of clinical coding on payment
- Good presentation and report writing skills
- Excellent client management skills
- Ability to network effectively with peers
- Knowledge of Data Protection, Information Governance and Patient Confidentiality requirements
12
Coding Auditor Resume Examples & Samples
- Performs coding quality reviews, provides feedback to coders, and educates coders
- Performs coding quality reviews in collaboration with or for internal divisions of the organization. Provides feedback and education as appropriate depending on findings
- Analyzes and interprets documentation from medical records and completes accurate coding of diagnoses and procedures
- Abstracts and validates required data elements into the coding and abstracting screens/system
- Communicates with providers for missing documentation or questions regarding documentation and offers guidance and education when needed
- Reviews, researches, and processes billing edits working collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately. Reviews and edits charges
- Works collaboratively with the Clinical Documentation Specialists and Coaches to communicate opportunities for accurate, complete and compliance documentation
13
Maps Coding Auditor / Analyst Resume Examples & Samples
- Exercise professional judgment, work independently with minimal supervision, and utilize time and resources effectively
- Utilize available data analytic tools to identify aberrancies in provider billing in relation to diagnosis code, procedure code and/or DRG assignments
- Apply working knowledge and ability to extract, analyze and review paid healthcare claims data and healthcare records to identify aberrant situations and/or potential fraud, waste or abuse
- Apply working knowledge and ability to conduct independent comprehensive analysis of billed diagnosis and procedure coding, APC or DRG assignment, and appropriate National Uniform Billing Committee coding to ensure billed coding is compliant with national coding principles, guidelines, and initiatives, as well as agency rules and regulations
- Apply pertinent administrative codes, regulations, policies, guidelines, publications, and patient care standards when conducting coding reviews
- Document coding review findings using methods and practices of evidence gathering and processing, and interviewing while maintaining confidentiality
- Review program integrity activities conducted by contracted entities
- Research and analysis of managed care plan encounters, policies and procedures, financial, administrative, accounting, and claims payment records
- Refer cases identified as having potential fraud and abuse to the Fraud Investigations Team for further investigation
- Refer cases identified as having potential quality of care or licensing issues to the agency's Quality Management Team or Department of Health (DOH)
- Support peers by coaching and mentoring clinical coding review protocols
- Respond to written and/or oral disputes and/or questions regarding coding review findings and/or the coding review process
- Participate in dispute resolution process and administrative hearing process, including providing evidence and/or testimony in support of administrative or judicial appeals
- Use creative and innovative approaches to achieve results and resolve problems
- Ability to identify and refer cases of questionable medical necessity or level of care to the Nurse Auditors for further review
- Working knowledge of and ability to review inpatient and outpatient medical records and apply ICD-9 & 10-CM/PCS and CPT/HCPCS coding; and DRG/APC assignment
- Working knowledge and application of ICD-9 & 10-CM/PCS and CPT/HCPCS coding conventions and guidelines, UHDDS guidelines, and national medical review standards
- Working knowledge and ability to analyze hospital inpatient and outpatient medical records for appropriate coding, DRG and APC assignment
- Working knowledge of correct coding in CPT Evaluation and Management services
- Working knowledge and ability to analyze coding findings and recognize trends of improper coding practices
- Working knowledge of clinical coding theory and practice in healthcare setting
- Ability to exercise professional judgment, work independently with minimal supervision, and utilize time and resources effectively
- Knowledge of state and federal rules and regulation; agency rules, policies and procedures pertaining to Washington State's Medicaid and Medical Assistance programs
- Knowledge of Health Insurance Portability and Accountability Act and Personal Health Information privacy rules, regulations, and policies
- Knowledge of ProviderOne payment system
- Knowledge of the State's medical assistance program cost reimbursement methodologies and regulations
- Written and verbal communication skills, to include public speaking and negotiation
- Ability to work effectively in an adversarial environment
- Working knowledge of Microsoft Office products and Internet
- Knowledge of the Health Care Authority organization, mission, values and goals
- Familiarity with and an understanding of audit standards established by the U. S. Government Accountability Office (GAO) in the publication Government Auditing Standards (GAS)
14
Coding Auditor Resume Examples & Samples
- Perform periodic quality audits of documentation and coding in EpicCare
- Analyze results and prepare summary feedback for individual clinicians, making recommendations for improvement
- Contribute to the maintenance of tools to audit service data
- Provide coding consultation to specialists or primary care clinicians are assigned on coding and documentation questions
- Within assigned clinical specialties, maintain current knowledge to ensure that KPNW coding and documentation meets regulatory guidelines and audit standards, and results in appropriate reimbursement
- 2 years work experience in an outpatient healthcare setting (see below for exception)
- 6 months of outpatient coding experience (see below for exception)
- Medical Terminology is required
- Require CPC or CCS Certification with in 18 months of hire date
- Required Cert is an acceptable equivalent to outpatient coding experience and work experience
- Must have completed coding and auditing training modules with satisfactory scores
- Must have achieved competencies as outlined in training objectives
- Ability to write reports summarizing audit findings and recommendations
- Working knowledge of medical terminology and pathophysiology
- Strong time management skills and ability to meet deadlines
- Prefer 1 year outpatient work experience at a KP facility
- Prefer 1 year of outpatient coding experience
- Completion of an accredited Health Information program and certification as a CPC or CCS is preferred
- Working knowledge of a medical specialty, including the clinical conditions seen and procedures performed
- Working knowledge of the EpicCare system
15
Corporate Outpatient Coding Auditor Resume Examples & Samples
- Reviews patient records for accuracy in ICD-9-CM coding, CPT coding and APC assignment
- Provides coder education via the auditing process
- Prepares and distributes the audit final reports
- 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. This includes review of all HCPCS and CPT codes impacting APC assignment
- Prepares preliminary results for review by the facility or CCS HIM director
- Reviews APC change disagreements with the Director of Coding Audits and Denials Management
- Prepares the final reports for the coding audit
- Provides coder education via conference call using the audit spreadsheet findings and comments
- Maintains productivity levels set forth by Community Health Systems
- Consults Director of Coding Audits and Denials Management regarding coding issues
- Attends coding workshops as necessary
- Keeps abreast of regulatory changes
- Maintains proficiency in AHA Coding Clinics, AHA Coding Clinics for HCPCS, CPT Assistant, and the official guidelines for coding and reporting
- Other duties as assigned by Director of Coding Quality and Education
16
Team Lead-coding, Auditor Resume Examples & Samples
- At least two (2) years recent coding experience required with at least one (1) year leading teams experience in a health care setting preferred
- AHIMA or AAPC Coding Certification required (CCS-P, CPC, COC, or CPC-P) required. Knowledge of Epic Resolute and Ambulatory, PowerPoint, Excel, including charts and pivot tables
- ICD-10, CPT, and HCPCS coding knowledge inclusive of associated billing edits such as NCCI. Ability to review, analyze, and interpret billing guidelines and state and federal regulations
17
DRG Coding Auditor Resume Examples & Samples
- Reviews medical records and coding to validate clinical coding
- Enters all required DRG review information into encoder program to obtain validated DRG
- Identifies questionable encoder results and reviews with program manager
- Takes responsibility for updating status of audit in NAS/Cares system
- Schedules and performs onsite audits in accordance with National Audit policies and procedures
- Performs desk audits in accordance with National Audit policies and procedures
- Works independently in remote locations
- Escalates facility issues to manager for resolution
- Review appeal information and render coding decision to either uphold or overturn original finding
- Participate in Inter Rater Reliability quality reviews
- Comply with all National Audit Employee Handbook policies and procedures
- Comply with HIPAA and other regulations regarding confidentiality of information
- Adhere to established NAS Audit Policies and Procedures
- CCS or CPC
- Two years inpatient hospital coding experience
18
Senior Consultant / Hospital Coding Auditor Resume Examples & Samples
- Project management with scheduling, coordinating and conducting audits and education based on client need & request
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Provide documentation of audit findings, report writing, and presenting audit findings and project deliverables to clients
- Assisting clients with case selection for audits and educating clients on systems
- Provides explanations and information to others on difficult issues
- Works directly with customers to define other project requirements, provide assistance to answer questions related to project results
- Assist as needed with other Reimbursement Solutions projects
- 3+ years’ experience in health care or hospital operations
- Any one of the following certifications; RHIA, RHIT, CCS, CPC, ICD-10 Trainer credentials
- 2+ years professional consulting or client facing experience
- Willing to travel up to 50% of time
- Bachelor's Degree or equivalent work experience
- Prior consulting experience
- Project/program management experience, including demonstrated ability to lead multifaceted projects
- Demonstrated high level of proficiency in presentation skills to audiences of various sizes
19
Clinic Coding Auditor Resume Examples & Samples
- Maintains thorough and current knowledge and understanding of all job related electronic and manual systems, policies, processes, coding schemes, regulations and guidelines
- A change agent; capable of guiding teams in a dynamic and progressive environment
- Must possess one or more of the follow credentials: CCS-P or CPC
- 3+ years of ProFee coding experience
- Competency in ICD-10 diagnosis coding and CPT Procedural coding
- Microsoft Office Proficiency
- High School Diploma
20
Document & Coding Auditor, HD Resume Examples & Samples
- Audit patient records to validate codes and correct DRG assignment
- Audit pre-bill and post paid claims for accuracy
- Audit the accuracy abstracted data, e.g., POA, Discharge Disposition
- Audits outpatient records to validate accurate code assignment
- Collaborates and works with Senior Director of Compliance to develop and enhance audit tools
- Provides audit results from each audit in an educational fashion. Promotes coding and documentation questions using open communication. Serves as a resource to Kindred facilities related to coding, compliance, prospective payment, and national correct coding initiative. Provides ongoing education to coders, case managers, and other clinical staff
- Acts as a liaison between facilities to identify and resolve problems and concerns
- Reviews non-CC/MCC records to assure secondary conditions are reported accurately
- Provides statistical reports supporting the activities related to coding quality
- Maintains professional skills and refines expertise through appropriate educational/developmental activities and professional affiliations
- Assists with coding backlogs, as needed
- Knowledge of and adherence to the principles of health information in order to plan and organize coding audits
- Expertise and credentials in coding practices and official guidelines
- Strong Excel and MS Word knowledge required
- Expertise in ICD-9-CM, CPT and HCPCS Level II coding
- Expertise in MS-DRG Prospective Payment System
- Strong communication skills both oral and written
- Strong teaching skills
- Exceptional organizational, multi-tasking and follow-through skills
- Approximate percent of time required to travel: 10%
- 5 years coding and DRG auditing experience
21
Coding Auditor Resume Examples & Samples
- Assist in supporting the sales team with analysis and review of documentation for prospective clients
- May need to assist in prospective client meetings (require CPD approval)
- May need to assist in client education / in services as needed. (requires CPD approval)
- Assist in the timely delivery of monthly “ask the coder” articles for ReveNews publication
- Maintains confidentiality of sensitive information concerning patients, physicians, employees, clients, vendors, and the company
- Ensure compliance with all State, Federal, professional regulations as well as department rules, policies, and procedural manuals
- Adherence to Safety Regulations
- Adherence to HIPAA Regulations
22
Inpatient Coding Auditor Resume Examples & Samples
- Audit and educate new and established coders and auditors
- Coding credential required from AHIMA - CCS, RHIT, RHIA
- 3+ years of Inpatient coding experience
- 1+ year of Inpatient auditing / training experience
- Experience with multiple Electronic Medical Record systems
- Graduated from a reputable ICD-10 Training program and passed the ICD-10 assessment exam
- Must maintain active coding credential
- Ability to flex time to accommodate off shore training, education sessions and special projects and audits
23
Remote Coding Auditor Resume Examples & Samples
- Location/Facility – Baylor Medical Center – Carrollton
- Specialty/Department/Practice –Health Information Management
- Shift/Schedule – Full-time, Week day daytime
- H.S. Diploma/GED Equivalent
- 7+ years’ experience required
- RHIA, RHIT, CCS, CCS-P, CCA, CPC, CPC-P, COC, CIC or CIRCC certification required
- Minimum of one year of coding audit experience required
24
Coding Auditor, Remote Resume Examples & Samples
- Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW
- Knowledge of medical terminology, ICD-9-CM and CPT-4 codes
- Must display excellent interpersonal skills
- The coder should demonstrate initiative and discipline in time management and assignment completion
- Intermediate knowledge of disease pathophysiology and drug utilization
- Three years coding experience including hospital and consulting background
- Duties may require bending, twisting and lifting of materials up to 25 lbs
- Duties may require travel via, plane, care, train, bus, and taxi-cab
- Ability to sit for extended periods of time
- Floats between clients as requested
25
Coding Auditor Compliance Resume Examples & Samples
- · High School Diploma or equivalent, prefer Associate's Degree in a health related field
- · Supervisory experience required
- · AHIMA Certification or HIM Certification , preferred
26
CPC Coding Auditor Resume Examples & Samples
- Required: Medical Coder certification from an accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute)
- Claims experience preferred
- Computer skills: MS Office; adept with data-based and web-based applications
- Must be self-directed and organized, with good critical thinking skills
27
Medical Coding Auditor Resume Examples & Samples
- Audits external vendors’ coding based on medical record reviews
- Acts as the subject matter experts (SME) for proper risk adjustment coding and CMS data validation
- Conducts provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. Trains venues such as provider offices and hospitals via onsite visits, webinars, conference calls, email correspondence, etc
- Conducts all activities in relation to CMS RADV audits: medical record review, identifies best medical record, submits all necessary paperwork, transmits data to CMS, responds to all inquiries and provides expertise and support during the appeals process
- Works on additional risk adjustment audit requests (i.e. outside auditors’ requests)
- Researches medical records identified as “deletes” to determine final disposition
- Sits on the Medical Coding Specialists Help Desk with the ability to research coding questions through approved industry publications and to provide expert guidance
- Serves on the RADV Committee as subject matter experts
- Works in conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS Risk Adjustment guidelines are being met
- Analyzes MRA data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers
- Perform quality assurance auditing (i.e. ensure appropriateness and accuracy of ICD-9/ICD-10 coding) for WellCare’s Medical Coding Specialists
- Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re-training topics
- Required A Bachelor's Degree in a health related field or finance
- Required 3+ years of experience in a hospital or physician setting
- Required 3+ years of experience in coding with knowledge of RAPS
- Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Intermediate Ability to represent the company with external constituents
- Required Certified Professional Coder (CPC)
- Preferred Certified Professional Medical Auditor (CPMA) CPC required
- Required Intermediate Microsoft Outlook Knowledge in Microsoft Office including Outlook, Word, Excel, Visio, and Power Point
- Required Intermediate Other Knowledge of RAPS and HEDIS
28
Inpatient Coding Auditor Resume Examples & Samples
- Perform coding compliance and quality audits in support of Optum360's Compliance Program and client expectations
- Clearly document audit findings and calculate billing error rates
- Provide feedback and education as appropriate depending on findings
- Conduct ad hoc coding and billing audits as requested
- Assist client organization with internal or external Compliance reviews
- Educate and audit coders
- Stay abreast of relevant billing and coding guidelines concerning the current areas of audit focus
- 5+ years of inpatient coding experience
- Coding credential required - CCS and/or RHIT
- Minimum of 1 year of inpatient audit experience
- Registered Health Information Technician (RHIT)
- Bachelor’s Degree in related concentration such as Health Information Management (RHIA)
29
Outpatient Coding Auditor Resume Examples & Samples
- Analyze and interpret documentation from medical records
- Articulate audit findings appropriate for audience. Prepare written audit reports as needed summarizing audit findings and any corrective action necessary to mitigate risk
- Educate and audit onshore and offshore coders
- Stay abreast of relevant LCDs, NCDs, billing and coding guidelines concerning the current areas of audit focus
- Research, develop and present education to coders as needed
- Conduct auditor peer review audits as requested
- 5+ years of outpatient coding experience in all chart types
- Coding credential required - CPC or CCS-P
- Minimum of 1 year of Outpatient (OP Surgery, Observation, ED, Ancillary, OP Clinic, ED facility) audit experience or Professional Evaluation and Management audit experience
- Familiarity with the revenue cycle as it relates to coding, auditing and billing
- Experience with various Electronic Health Records
- Registered Health Information Technician (RHIT) and CCS a plus
- Experience working remote
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Director, Coding Auditor & Educator Resume Examples & Samples
- Performs coding quality audits and special project reviews
- Review claim denials and rejections pertaining to coding and medical necessity issues and implements corrective action
- Develops coding quality audit reports (memo, executive summary, audit findings, and action plan)
- Analyzes data, identifies trends/conclusions (e.g. coding practices, case-mix changes, etc.), and proposes strategies for resolution and education opportunities. Provides education support on documentation, coding, billing and utilization review management. Prepares and presents educational programs related to coding
- Stay abreast of coding and billing requirements, company/department policies and procedures to effectively apply this knowledge to complex coding quality and compliance situations
- Proactive thinking and recommends action for improving coding compliance
- Serves as a resource for department managers, staff, physicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements
- Maintains an open dialogue, promotes collaboration and good working relationships with all members of the HSC and hospital teams
- Performs other department duties as assigned
- Associate or Bachelor degree in Health Information Management
- RHIS, RHIT or CCS credentials, preferred
- RN with CCS, preferred
- Minimum of 3-5 years of hospital coding, including knowledge of 3M coding/grouper
- Knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing
- Proficient with Microsoft software (Word, Excel and PowerPoint)
- Knowledge of Medicare and all payer reimbursement methodologies
- Knowledge of utilization management techniques
- Familiar with audit management techniques
- Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the Company and the immediate supervisor
- Must work with deadlines and related time pressure
- Knowledge of statistics, data collection, analysis, and data presentation
- Excellent interpersonal communication and problem –solving skills
- Travel 40% of the time
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Risk Adjustment Coding Auditor Medigold Corporate Service Center Resume Examples & Samples
- Identifies issues and trends in coding and documentation that affect provider risk adjustment factor scores. Evaluates and makes recommendations of code selection on the Risk Adjustment assignment to ensure proper level of payment
- Performs coding quality audits and evaluates clinical documentation of provider charts. Manages National Sample RADV audits which includes coordination of internal and external deliverables
- Oversight of third party administrators; performs quality audits on vendor charts, assesses and manages overall effectiveness of vendors
- Education: Associates degree required. Bachelor's Degree preferred
- Licensure / Certification: Certification: Coding Certification required (CPC, CCS-P, RHIT, or RHIA) Certified Risk Coder (CRC)
- Experience: Minimum one (1) year coding experience required. Knowledge of ICD, HCPC, and CPT coding conventions and clinical documentation
- Must possess an in-depth knowledge of current Medicare coding and billing requirements. Must possess extensive knowledge of auditing concepts, principles and current medical terminology
- Must possess strong written and verbal communication skills in order to communicate in clear, concise, terms to internal and external customers, including the ability to articulate complex regulatory information's in layman's terms
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Medical Coding Auditor Resume Examples & Samples
- Works collaboratively with the Senior Documentation and Coding Educator to support the system wide external audit program by providing remedial and ongoing education to providers focused on identified documentation discrepancies
- Works collaboratively with Senior Documentation and Coding Educator in support of new provider onboarding and orientation for Stamford Health physicians and non-physician practitioners. Provides documentation and coding education. Provides input on template development as needed
- Audits and reviews documentation in Practice’s medical record system with new SHMG providers prior to billing to ensure accuracy and understanding of coding and documentation concepts. Coordinates final approval to release providers from this review with Senior Documentation and Coding Educator
- Performs internal retrospective, concurrent or prospective medical chart audits to assure that CPT codes billed are appropriate and supported by documentation in the patient record, and that all coding/documentation combinations are compliant with Federal and State regulations
- Researches third party payer medical and administrative policy that may affect the practice’s clinical and billing operations. Assists Manager/Director to communicate changes to physicians, clinicians, office managers and third party billing staff. Assists in the development of training materials and presentations for effective provider and staff education
- Provides on going coding feedback and training to physicians and non-physician practitioners
- Reviews physician charge patterns by procedure, diagnosis, denial, insurance type and other insurance groupings as identified to develop targeted education for physicians and billing staff based on correct coding and third party payer coverage policy
- Maintains knowledge of Physician at Teaching Hospital requirements, Shared Visit and “Incident To” billing requirements
- Maintains current working knowledge of CPT, HCPCS and ICD-10 coding principles, government regulations, protocols and third party requirements regarding billing and compliance
- Consults with physicians and physician staff, as needed, on documentation issues, and other regulatory issues as they arise
- Assist in review and assessment of findings from third parties that provide coding validation audits. Formulate and write appeals when appropriate and/or educate Coder(s) when required
- Assists in training new team members of the department on their job role in coding, auditing and education; provides continued guidance and mentoring as requested by Manager
- Prepares audit reports containing adequate evidence to support audit findings and makes recommendations. Presents providers with individualized report results
- Identifies and determines that the integrity of coding and revenue generation is supported by the documentation. Escalates issues as appropriate to the Professional Billing Operations Manager, Executive leadership, providers, clinical staff, coding staff, and other departments and provides recommendations accordingly. Assists in the assessment of impact of current compliance activities and risk evaluation
- Participates in decision making concerning policies and procedures as requested. Assists Manager in writing and implementation of new policies and procedures related to coding and documentation
- Works closely with providers, leadership, coding staff and clinical staff. Communicates with providers, clinical staff when needed in order to address all needs and concerns in a timely manner
- Shadows providers and works individually and jointly with EMR Implementation Specialists to assist providers in the development of documentation and templates
- Participates in committee work and on cross functional teams as requested by department management
- Participate in staff meetings, training and conference calls as requested
- Participates in workshops, seminars, audio conferences and other educational opportunities to insure continued learning for self-improvement
- Seeks out and analyzes opportunities to improve and enhance coding activities among physicians and staff. Provides feedback to Professional Billing Operations Manager
- Displays customer service focused attitude and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession. Handles stressful situations with professionalism and tact
- Maintains strict patient and physician confidentiality and follows all federal, state and organization guidelines for release of information
- Serve as a resource for department managers, physicians, and administration to obtain information and clarification on accurate and ethical coding standards, guidelines and regulatory requirements
- High School diploma required. Bachelor’s or Associate Degree in Business/Healthcare preferred, clinical experience/clinical licensure (LPN, RN) a plus
- At least three (3) years recent coding experience required. At least one (1) year coding and documentation auditing experience in a health care setting required
- Must possess and maintain AAPC Certified Professional Coder (CPC) certification. CPMA or equivalent auditing certification required
- Advanced ICD-10, CPT, and HCPCS coding knowledge inclusive of associated edits such as NCCI
- Demonstrated research and presentation skills
- Possess effective time management skills to permit handling of large workload
- Foster a culture of learning in a non-confrontational manner. Demonstrated ability to educate and motivate staff
- Ability to review, analyze and interpret billing guidelines and state and federal regulations
- Strong organizational skills to prioritize multiple tasks and maintain highly detailed information in a fast paced environment
- High level of competency with computers, electronic medical records, the Internet, and computer software such as MS Office or equivalent is required
- Considerable knowledge of medical office operations and medical terminology is required
- The ability to work with individuals at all organizational levels, particularly peers, team members, and other departments
- Ability to work independently with minimal supervision
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Coding Auditor Resume Examples & Samples
- Consults facility leaders and staff on best practices, methodology, and tools for accurately coding
- Chart Analysis, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA/AAPC). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA)
- Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate ESRD designation. Reviews medical records for the determination of accurate assignment of all documented ICD-10 codes for diagnoses and procedures
- Uses discretion, experience and specialized coding training to accurately assign ICD-10 codes to patient medical records
- Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by Fresenius policy
- Reviews medical records to determine accurate required abstracting elements (clinic specific elements) including appropriate discharge disposition
- Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution
- Evaluates and prepares as indicated daily, weekly and monthly reports indicating quality levels and opportunities for charge capture and revenue maximization
- Monitors, prepares and presents reports including, but not limited to, Medical Record Delinquency Rates, Clinical Pertinence, H & P Compliance, Operative Note Compliance
- Develops and delivers education to horizontal and vertical audiences on coding and charge capture
- Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10 coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-10 and CPT updates) for outpatient coding. Quarterly review of AHA Coding Clinic. Attends or facilitates Quarterly Coding Updates and all coding conference calls
- 2+ years related experience
- Must be detail oriented and have the ability to work independently
- Extensive knowledge of medical record documentation requirements mandated by Medical Staff Bylaws, Rules and Regulations
- State and federal regulations regarding patient confidentiality
- Thorough/detailed knowledge of ICD-10 and CPT coding systems
- Skilled in formulating and writing statistical reports Skilled in performing quality assessment/analysis
- Knowledge of disease pathophysiology and drug utilization
- Knowledge of MSDRG classification and reimbursement structures
- Knowledge of APC, OCE, NCCI classification and reimbursement structures
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Coding Auditor Resume Examples & Samples
- Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS)
- Experience performing hospital based inpatient and outpatient coding, utilizing the most current versions of International Classification of Diseases (ICD) and Current Procedure Terminology (CPT)
- Experience training and/or teaching in an acute care hospital setting
- Advanced knowledge of coding principles, disease process and
- Bachelor’s degree or may substitute an Associate’s degree or equivalent from a two-year college and five years hospital setting experience, with credential Certified ICD-10-CM/PCS Trainer Experience working with management of the Quality Department, Clinical Documentation Improvement Programs, and other key stakeholders
- Experience with Epic and Quantim
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Inpatient Coding Auditor Resume Examples & Samples
- Certification as CPC, CCS, CHC, RHIA, RHIT, RN, or LPN or other related certification
- Must have computer skills and dexterity required for data entry and retrieval of required job information
- Must be proficient with Windows-style applications, keyboard, and various software packages specific to role
- Ability to work with high integrity
- Bachelor's degree in Health Information Management, Accounting, Finance, or related Healthcare field. Additional degrees, business training experience, and/or certifications may be combined to meet minimum qualifications
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Provider Coding Auditor Resume Examples & Samples
- 3 years' experience in healthcare audit, billing, compliance or specialized coding
- Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process
- Ability to work self-directed, under minimal supervision
- Reliable transportation to travel between facilities
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Medicare Coding Auditor & Educator Resume Examples & Samples
- CPCcertification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required
- Working knowledge of Medicare Risk coding preferred
- Must have strong presentation skills
- Microsoft office/PowerPoint presentations a plus
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Risk Coding Auditor Resume Examples & Samples
- Education:High School Diploma
- Licensure:Type and click [Enter] to add additional text
- Experience:At least 5 years coding related experience with diagnosis and physician coding. Proficiency with ICD-10-CM coding is required
- Certification/Registration:RHIA, RHIT, CCS, CCS-P, CPC, CPC-P, COC, CPMA, CIC, CRC, CIRCC
- Other Skills and Knowledge
- Ability to work with minimal supervision to accomplish and carry out goals and objectives
- Ability to summarize and communicate results of reviews and facilitate education
- Some travel may be required to attend meetings and/or conduct presentations
- Advanced working knowledge and a high level of experience with the ICD-10-CM coding classification systems
- Ability to answer questions regarding the ICD-10-CM classification system
- Education:A.S from an accredited Health Information Technology program or B.S. from an accredited Health Information Management Program
- Experience:Minimum 5 years risk adjustment coding and/or professional auditing experience
- Certification/Registration:Certification in ICD-10-CM coding and/or training, RHIA, RHIT Plus CCS and/or CPC, CRC – Certified Risk Adjustment Coder
- Working knowledge of Microsoft Applications
- Working knowledge of 3M encoder
- Experience with Epic EHR
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NM Regional Medical Group Coding Auditor Resume Examples & Samples
- Three years of coding and auditing experience (inpatient/outpatient/ASC). EMR experience a must. Experience in interpreting paper charts, EMR records, ancillary reports, governmental payer and commercial payer guidelines
- Coding certification required through AAPC or AHIMA - CCS-P, CCS or CCA, CPC or CPC-A
- Consistently meets productivity standards established for Coder III position for 6 months. Ability to communicate in English effectively with providers and clinical departments, and Support Services staff as required. Excellent interpersonal skills. Ability to adjust to changing dynamics and business conditions. Proficiency in Microsoft Office Applications desired
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Coding Auditor Resume Examples & Samples
- 5 years of experience in healthcare, including 3 years of experience in physician practice coding, documentation, billing, and/or reimbursement
- Coursework or degree
- Proficient in Microsoft Office, including Word and Excel
- Experienced problem-solver
- Demonstrated customer focus
- Maintains current knowledge of federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG compliance standards
- Conducts coding, billing, and documentation compliance audits within established timeframe and in accordance with the standards defined by Children's Healthcare of Atlanta
- Prepares a report of findings and recommendations for improvement for each audit
- Serves as a subject matter expert on coding/billing topics
- Researches issues/questions and responds to internal inquiries
- Assists the Physician Auditor Coordinator with developing a detailed audit plan for area being reviewed
- Meets audit productivity standard
- Meets annual requirements to maintain coding certification
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Medical Coding Auditor Resume Examples & Samples
- Reviews medical and behavioral health treatment records and independently codes, abstracts and analyzes inpatient and outpatient medical records using the most current International Classification of Diseases (ICD-9/ ICD-10), Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB) and other codes according to federal and state statutory, regulatory and contractual requirements, AMA guidelines, other regulatory agencies and generally accepted coding practice
- Verifies and validates authorization of services, written clinical documentation of services received through physical health services and behavioral health utilization management departments and information contained in the health care claims systems against claims, medical records and anomalies, abnormal billing patters and other indicators (e.g., services not rendered, up-coding, un-bundling, etc.) of suspected fraud and abuse
- Coordinates individual work activities with SIU Manager and Investigators, develops and presents findings and recommendations regarding the appropriateness of diagnosis and procedure codes submitted on provider service claims and supports overpayment recovery during discussion with medical and behavioral health care providers
- Coordinates coding and payment issues with other areas and departments as required
- Provides detailed written review of audit findings to management, plan representatives and State Regulatory Agencies
- Presents findings and provide testimony in legal proceedings as required
- Must be able to use data analysis and extraction tools to evaluate transactions and identify potential billing errors or misstatements
- Must be able to integrate current industry changes into a clinical audit practice setting
- Must be proficient with Medicare/Medicaid guidelines. Understanding of federal and state laws and regulations in medical reimbursement
- Understanding of anatomy and physiology, disease process, medical terminology and pharmacology
- Works independently following established policies, procedures and practices
- Consistently and positively communicates and collaborates with colleagues, supervisors, managers and customers both internal and external
- Efficiently and independently plans time, meets deadlines, initiates and follows through on tasks
- Listens respectfully and carefully, demonstrating flexibility in working with others in a team based environment
- 1 to 3 years experience in Medical Coding Nurse preferred
- Certified Professional Coder (CPC) required
- Facility or Hospital Chart Review experience preferred
- MS Office - Excel and Case Management documentation
- Telecommuting options available for individuals not located in the Philadelphia area
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Manger, Coding Auditor Compliance Resume Examples & Samples
- · Bachelors Degree in Health Information Management or Associate's Degree in Health Information Technology
- · Three years supervisory experience in an acute hospital setting
- · AHIMA Certification or HIM Certification
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Inpatient Coding Auditor Resume Examples & Samples
- This is a virtual position with ability to work from any location n the U.S. near an Adventist Health site
- Highly organized with the ability to manage time and prioritize work effectively
- Display strong interpersonal and excellent problem solving skills
- Possess excellent written and verbal communication skills
- Maintains thorough and current knowledge and understanding of all job related electronic and manual systems, policies, processes, coding schemes, DRG groupers, regulations and guidelines
- Must possess one or more of the follow certifications: RHIA, RHIT, or CCS
- At least 3 years of experience inpatient coding experience (acute care hospital)
- Competency in ICD-10 diagnostic and procedure coding
- Must reside near an Adventist Health site or be willing to relocate
- At least one other coding specialty certification
- At least 1 year of auditing experience
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Professional Fee Coding Auditor Resume Examples & Samples
- Communicates coding updates published in third-party payer newsletters, bulletins, and provider manuals to physician staff
- Participates in the review and revisions of pertinent billing functions and procedural processes
- Performs other job related duties as required
- Associates Degree from an accredited college or university
- 3 plus years of experience working with ICD-10-CM, HCPCS, CPT-4, and E&M codes
- 2 plus years of experience with coding auditing
- American Health Information Management Association (AHIMA) granted: Registered Heath Information Administrator (RHIA), Registered Health Information Technologist (RHIT), or Certified Coding Specialist Physician (CCS-P) credentials
- Proficient computer skills including Microsoft Office Outlook, Excel, Word, and PowerPoint
- Associates Degree in Medical Billing & Coding
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DRG Coding Auditor Resume Examples & Samples
- Reviews inpatient medical records for select payer populations post-discharge and pre-bill; audits the accuracy and completeness of diagnosis and procedure coding, DRG assignment, and abstracted data - POA, Discharge Disposition
- Reviews discrepancies between the Clinical Documentation Specialist (CDS) DRG and the Coder DRG
- Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed
- Works with coders and CDS's to draft and initiate physician queries
- Performs reviews in a timely manner to maintain DNFB target of 5 days
- Develops and coordinates educational and training programs regarding technical coding and clinical topics for the coding staff
- Develops and implements education of physician, nursing, and other clinical staff to improve documentation to yield better coding
- Certified Coding Specialist (CCS) certification. RHIA/RHIT preferred
- Minimum five (5) years experience with coding ICD9
- Previous experience in performing DRG coding audits
- Possesses knowledge of DRG and grouping methodologies; in particular what diagnoses / procedures impact DRG assignment
- Basic computer skills in word processing and spreadsheet utilization
- Excellent interpersonal skills to develop relationships necessary to facilitate and educate
- Excellent prioritization and organizational skills
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Coding / Auditor Educator Resume Examples & Samples
- Certification from AAPC (CPC, Certified Professional Coder), RHIT, RHIA or other certification or licensed RN or similar clinical license is required. Certification from AAPC (CPMA, Certified Professional Medical Auditor) or any other auditing certification preferred
- Associates Degree or minimum of 2 years of related experience required
- Two years of health information technical training with knowledge and/or skills in coding with ICD-9-CM and CPT is preferred
- Minimum of three (3) years’ experience in physician, hospital coding or other healthcare field such as CDI, revenue integrity or hospital coding is required
- Strong interpersonal skills necessary for interacting with physicians, team members and all customers. Skilled at facilitating discussions, meetings and sharing/teaching information to wide variety of customers/learners
- Skilled at Microsoft office including Word, Excel and PowerPoint
- Ability to analyze and interpret data ; ability to identify trends
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Coding Auditor Resume Examples & Samples
- Develops a detailed audit plan for area being reviewed by maintaining a close working relationship with Coding Management and Leaders to meet established goals and responsibilities of maintaining consistent quality monitoring processes to validate coding and billing accuracy that minimize denials
- Conducts the coding and billing compliance audit process within established timeframe and I accordance with the standards defined by Piedmont Medical Care Corporation
- Prepares a report of findings for each audit and the action plan for implementation of recommendations for correction and/or improvement
- Monitors the progress of developed action plans by developing and administering coding education program(s) that ensure providers and staff maintain coding and billing competencies and are current with coding requirements and regulations, ensuring that current coding manuals are provided for each practice office, and acting as coding and billing compliance resource for the employed physicians at Piedmont Medical Care Corporation
- Utilizes available resources and continuing education programs to remain knowledgeable and current with coding and billing compliance regulations. Meets annual requirements to maintain CPC or CCS-P certification
- Ability to interact with physicians and non-physician practitioners
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Coding Auditor Educator Resume Examples & Samples
- Candidate must be willing to obtain clearances as well as attend training on site**
- Plans and conducts audits and reports on the documentation, coding and billing performed at AHN entities
- Reviews, develops and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements. Provides written audit guidance
- Participates with management in the assessment of external audit findings and responds as needed. Attends meetings and interacts with management to resolve issues and provide advice on new programs
- Provides guidance to system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare appeal letter follow up and identify education issues
- Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial impact and profitability
- Conducts education/training presentations of final audit findings to department staff, physicians and appropriate individuals
- Validates the ICD CM, ICD PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure and regulatory requirements
- Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the charge master
- Creates and monitors inpatient case mix reports and the top 25 assigned DRGs/APCs in the facilities to identify patterns, trends and variations in the facilities frequently assigned DRG/APC groups
- Once identified, evaluate the cases of the change or problems and takes appropriate steps to effect resolution
- Provides or arranges for education/training of facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology and disease processes as it relates to the DRG/APC and other clinical data quality management factors
- With technical direction and assistance from management, designs and implements coder education program, continuing education programs and Medical Staff education programs
- Establishes and monitors performance and maintains appropriate documentation thereof
- Reviews and interprets medical information, classifies that information into the appropriate payor specific groups consisting of ICD CM ICD PCS and CPT codes for diagnoses and procedures and calculates the DRG and APC
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines
- Assures compliance with the coding guidelines and regulatory requirements
- Performs other duties as assigned or required including performing audits and research related to special projects and providing coverage for coding manager(s)
- Develops and implements an organizational framework for quality and safety
- In conjunction with the Director Quality and Safety Allegheny Clinic, will develop indicators for both quality and safety to measure and improve upon
- Monitors and analyzes data to provide information to support the quality improvement process and learning
- Demonstrates an acute understanding of HEDIS, outcomes management and nationally recognized quality processes such as NCQA
- Provide leadership and education around safety
- Co-chair the multi-disciplinary Allegheny Clinic Quality and Safety team
- Will travel frequently to various site locations throughout the Health Network
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Coding Auditor Resume Examples & Samples
- Audits specified number of records per coder as defined in the system coding audit plan
- Prepares and distributes audit results/reports for the system coding compliance program
- Identifies trends and educational opportunities. Prepares and presents educational programs related to coding
- Assists with other audits as requested
- Assists in developing and maintaining policies and procedures for coding and coding guidelines.Performs other duties as assigned
- Assists in hiring and training new coders and provides input in performance evaluations
- Assists team members with issues requiring immediate attention
- Serves as resource to staff and acts as a liaison to physicians and other medical support staff
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Coding Auditor Senior Work Home Resume Examples & Samples
- Requires a high school diploma; 3 years of experience as coder of medical records in physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background
- BS in health sciences, health management or related field preferred
- Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required
- Experience working with Medicare Advantage preferred
- Experience with ICD-9/ICD-10 coding a plus
- HCC coding preferred
- Previous experience as a clinician a plus, but not required
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Coding Auditor & Educator Resume Examples & Samples
- Working on CCI edits and other regulatory guidance
- Developing, implementing, delivering and assessing coding education plans using a variety of methods to individual providers or provider groups
- Understanding of Healthcare insurance guidelines as relevant to correct coding initiatives is necessary
- Successful completion of a post-secondary billing or coding program or coursework, or the equivalent combination of experience, education and training is required. Medical Terminology, Anatomy & Physiology or Pathophysiology coursework required
- CPC, CCS-P or PCS required
- One year experience in surgical and outpatient procedural coding is required
- Ability to assign, sequence and validate all CPT, ICD-9, HCPCS codes with appropriate modifier usage is required
- Undergraduate degree in a health or business related field strongly preferred
- At least five (5) years E&M coding/auditing experience in any medical specialty, with greater experience preferred
- RHIA and/or RHIT will be considered Additional specialty certifications strongly preferred
- Experience in professional-fee billing is desired
- Additional nationally-accredited continuing education in a medical auditing, surgical or specialty coding methodology is strongly preferred
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Contract Coding Auditor Resume Examples & Samples
- Audits medical record documentation to identify under-coded and up-coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues
- Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services
- Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation
- Trains, instructs, and/or provides technical support to medical providers and Medical Coding Analysts as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements
- Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and data management systems to coordinate these with established methodology, to ensure that client billing operations meet the joint requirements of the local facility
- Interacts with providers and management to review and/or implement codes and to update charge documents
- Ensures strict confidentiality of financial and medical records
- Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations
- Performs miscellaneous job-related duties as assigned
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Coding Auditor Resume Examples & Samples
- Performs Coder Compliance Auditor responsibilities for sections in the central Medical Records department and/or satellite departments
- Provides technical expertise and leadership on coding and coding related issues through multiple mechanisms, participate in project teams dealing with coding and quality data issue
- Compiles and analyzes administrative and health statistics for reimbursement, quality assurance using manual or computerized methods as appropriate. Complies and generates Core reports and Pull list
- Codes and validates diagnoses and procedures of discharged, observation, and/or outpatient medical records using either the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), the Current Procedural Terminology (CPT-4) or ICD-9 or other relevant approved classification system. Maintaining a 95% accuracy rate for both coding and audits when conducting quality reviews. Assures accuracy of entry of assigned codes into computer abstracting system
- Current accreditation by the American Health Information Management Association as a RHIT, RHIA, CCS, or CCS-P
- Minimum of an Associate’s degree in Health Information Technology or an Independent Program in Health Information Technology (ISP/HIT) from an accredited school of health information/health information administration
- Minimum total of eight years coding experience in an acute care setting
- Minimum of three years ICD-9_CM and CPT coding and abstracting experience in a health information department
- Minimum three years experience with DRG’s and the understanding of APR’s/APC is highly beneficial, physician billing, statistical analysis
- Three years experience with interpretation and analysis of quantitative and qualitative statistical reporting to monitor, measure and evaluate individual and group performance
- Minimum of two years experience in auditing inpatient and ambulatory/outpatient records
