Facility Coding Quality Specialist (Auditor)

CorroHealth Inc; Town of Texas (WI); On-site; USD 60,000 - 80,000; Full time

Job summary

CorroHealth Inc in Wisconsin is looking for a qualified Coding Auditor to perform complex analyses of medical records to identify errors and ensure compliance. The position requires a recognized coding credential and at least two years of related experience.

The Coding Auditor will collaborate with coders, providing technical support and monitoring quality. Strong communication and analytical skills, coupled with attention to detail, are essential for success. The role offers a supportive work environment with opportunities for professional development.

Qualifications

• Minimum 2 years experience coding and/or auditing in inpatient and outpatient facilities.
• Experience with telecommuting and electronic medical records systems strongly preferred.
• Familiarity with hospital outpatient billing processes.

Responsibilities

• Performs complex retrospective analysis of medical record documentation.
• Provides second-level review of diagnosis, procedure, and billing codes.
• Monitors ongoing progress and success of each coder.

Skills

Strong verbal and written communication skills

Strong analytical skills

Team player

Attention to detail

Education

Recognized coding credential from AHIMA or AAPC

Coding Certification (CPC or CCS)

Tools

Microsoft Office applications (Word and Excel)

Electronic medical records systems

Job description

Responsibilities

• Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant.
• Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence.
• Provides second–level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies.
• Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third party payer requirements, medical necessity requirements.
• Protects the privacy and confidentiality of patient health and client information.
• Adheres to the Standards of Ethical Coding as set forth by AHIMA and to official coding guidelines and compliance practices.
• Suggests physician query opportunities, queries physicians based upon documentation and clinical needs.
• Prepares deliverables for the coders as required.
• Reports work time and work productions in a timely and accurate manner.
• Communicates with coworkers in an open and respectful manner which promotes teamwork and knowledge sharing.
• Provides schedule of planned work activities, events and sites, and any changes to management and appropriate staff.
• Maintains professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education.
• Monitors the on‑going progress and success of each coder.
• Maintains QA percentages within two internal quality goals: overall minimum coder accuracy of 95% and QA review percentages as close to 10% as possible.
• Identifies and resolves coding quality problems or issues in a timely manner, maintaining a continual knowledge of problems or issues that could affect coding quality levels.
• Assists in design of systems to help improve coder productivity and accuracy.
• Provides monthly reports, participates in corporate training and meetings, and provides status reports to senior manager as requested.
• Interprets coding guidelines for accurate code assignment and understands the importance of documentation on code assignment and reimbursement impact.
• Complies with all internal policies and procedures, actively participates in company provided training and education, and ensures compliance with privacy and security rules.

Qualifications and Requirements

• Regular, predictable and punctual attendance required.
• Strong verbal and written communication skills required.
• Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy.
• Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered.
• Experience with telecommuting and electronic medical records systems strongly preferred.
• Strong analytical skills.
• Excellent written communication skills.
• Strong team player.
• Ability to work with multiple and diverse clients and projects.
• Ability to work with minimal supervision.
• Minimum 2 years (preferably 3 years) experience coding and/or auditing in inpatient and outpatient facilities.
• Initiative, resourcefulness and attention to detail.
• Customer service support – minimum 1 year experience.
• Familiarity with hospital outpatient billing processes.
• Understanding hospital APC assignment and associated coding and documentation.
• Coding Certification – preferred (CPC or CCS).
• Proficient in Microsoft Office applications including Word and Excel.
• Ability to navigate in a variety of EMR environments and review hand‑written charts.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Regular eye‑hand coordination and manual dexterity are required to operate office equipment. The ability to perform work at a computer terminal for 6‑8 hours a day and function in an environment with constant interruptions is required. At times, team members may be required to sit for prolonged periods. Infrequently, team members must be able to lift and move material weighing up to 20 lbs. Team members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.