Coding Audit & Education Specialist

Highmark Health; Philadelphia (Philadelphia County); In loco; USD 39.000 - 61.000; Tempo pieno

Descrizione del lavoro

Allegheny Health Network is seeking a Coding Audit Specialist to perform internal and external coding audits, ensure data quality, and support compliant coding and billing practices. You will review records, validate codes, and communicate results to stakeholders to drive process improvements.

The role involves developing training materials, reporting audit findings, and collaborating with management on education and reimbursement optimization in line with regulatory guidelines.

Competenze

• High school diploma or GED required; AHIMA/AAPC credentials preferred.
• In-depth knowledge of ICD-CM, ICD-PCS, CPT/HCPCS coding systems and DRG/APC structures.
• Proficiency with encoder, grouper, and abstracting software; familiarity with Coding Clinic references.

Mansioni

• Plans and conducts audits and reports on coding and billing at AHN entities.
• Develops audit summaries and educates staff on deficiencies and education plans.
• Validates ICD-CM/PCS, CPT and HCPCS codes and DRG/APC structures for compliance.
• Interprets medical information and assigns payor-specific codes for diagnoses and procedures.
• Mentors staff and provides training; responds to external coding audits.

Conoscenze

Analytical skills

Communication skills

Attention to detail

Formazione

High school diploma or GED

AHIMA/AAPC coding credentials

RHIT/CCS or CPC/COC/CPMA certification

Strumenti

Encoder software

Grouper/abstracting system

Coding clinic references

Descrizione del lavoro

Allegheny Health Network is seeking a Coding Audit Specialist to perform internal and external coding audits, ensure data quality, and support compliant coding and billing practices. You will review records, validate codes, and communicate results to stakeholders to drive process improvements.

The role involves developing training materials, reporting audit findings, and collaborating with management on education and reimbursement optimization in line with regulatory guidelines.