Coding Auditor I

National Association of Mutual Insurance Companies; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading association seeks a Coding Auditor 1 responsible for conducting coding quality audits and ensuring compliance with coding rules. The role includes collaborating with medical professionals and validating data accuracy. Ideal candidates will have significant coding experience, relevant certifications, and exemplary communication skills.

Benefits

Health and welfare benefits starting immediately

401(k) plan with up to 5% match

Tuition reimbursement

PTO accrual from Day 1

Qualifications

• Must possess one of the following certifications: RHIA, RHIT, CCS, CCS-P, COC, CPC, CIC, CIRCC.
• Minimum of 5 years of coding experience, with at least 1 year as a coding auditor.

Responsibilities

• Perform routine coding quality reviews on all coders including third-party suppliers.
• Provide feedback based on findings.

Skills

Communication

Flexibility

Knowledge of coding regulations

Computer proficiency

Education

H.S. Diploma/GED

Job description

Description

JOB SUMMARY

The Coding Auditor 1 is proficient in various types of coding and is responsible for performing coding quality audits and providing feedback to coders. The Coding Auditor 1 utilizes the International Classification of Disease (ICD-10-CM/PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT), and other coding references to ensure accurate coding. Coding references will be used to ensure accurate coding and grouping of classification assignment (e.g., MS-DRG, APR-DRG, APC, etc.).

ESSENTIAL FUNCTIONS OF THE ROLE

• Performs routine coding quality reviews on all coders including third-party suppliers as appropriate.
• Performs coding quality reviews in collaboration with or for internal customers of the organization.
• Provides feedback as appropriate depending on findings.
• Abstracts and validates required data elements into the coding and abstracting system.
• Works collaboratively with Clinical Documentation Specialists and Coaches to communicate opportunities for accurate, complete, and compliant documentation.
• Completes production coding when needed and assigned by a supervisor.

KEY SUCCESS FACTORS

• Strong knowledge of applicable rules, regulations, policies, laws, and guidelines impacting coding.
• Strong knowledge of transaction code sets, HIPAA requirements, and other issues impacting coding and abstracting functions.
• Strong knowledge of anatomy, physiology, and medical terminology.
• Competency in the use of computer applications, group software, and CCI edits.
• Expertise in ICD-10-CM/PCS coding and/or CPT procedural coding.
• Ability to interpret health record documentation for accurate code assignment.
• Strong communication skills, both verbal and written.
• Proficiency in computer usage.
• Flexibility and adaptability while adhering to regulatory and accreditation guidelines.

Qualifications

• Must possess one of the following certifications: RHIA, RHIT, CCS, CCS-P, COC, CPC, CIC, CIRCC.
• Minimum of 5 years of coding experience, with at least 1 year as a coding auditor.
• Educational requirement: H.S. Diploma/GED.

Benefits

• Health and welfare benefits starting immediately.
• 401(k) plan with up to 5% match.
• Tuition reimbursement.
• PTO accrual from Day 1.

About Baylor Scott & White Health

As the largest not-for-profit healthcare system in Texas, Baylor Scott & White Health was formed in 2013 from the merger of Baylor Health Care System and Scott & White Healthcare. It includes 52 hospitals, over 1,300 care sites, more than 7,200 physicians, and over 57,000 employees.