Medical Coding Auditor & Education Lead

Highmark Health; Pennsylvania; Hybrid; USD 39,000 - 61,000; Full time

Job summary

Highmark Health is seeking a Coding Auditor to perform internal, concurrent, prospective and retrospective coding audits. You will review medical records to ensure data quality and accuracy of coding, billing and documentation for DRGs, APCs, CPTs and HCPCS Level II codes, and ICD diagnoses and procedures.

You will develop training programs, provide guidance, and collaborate with management and external consultants to improve documentation and reimbursement compliance in line with HIPAA and

Qualifications

• Auditing experience in medical coding and documentation is required.
• Strong knowledge of ICD-CM/ICD-PCS, CPT/HCPCS, and DRG/APC structures.
• Certification from AAPC or AHIMA is required; RHIT/CCS preferred.
• At least 5 years of hospital or physician coding/auditing experience; teaching experience is a plus.

Responsibilities

• Plans and conducts audits of documentation, coding and billing at AHN entities.
• Develops and delivers training materials to address deficiencies per regulatory requirements.
• Provides written audit guidance and participates in external audit findings reviews.
• Communicates results to management and affected areas; supports education programs.
• Ensures compliance with coding guidelines and regulatory requirements; mentors staff.

Skills

Auditing experience

Medical coding knowledge

Analytical skills

Communication skills

Education

AAPC or AHIMA certification

RHIT/CCS credentials preferred

5 years hospital/physician coding/auditing

Tools

Encoder software

Grouper

Abstracting software

Job description

Highmark Health is seeking a Coding Auditor to perform internal, concurrent, prospective and retrospective coding audits. You will review medical records to ensure data quality and accuracy of coding, billing and documentation for DRGs, APCs, CPTs and HCPCS Level II codes, and ICD diagnoses and procedures.

You will develop training programs, provide guidance, and collaborate with management and external consultants to improve documentation and reimbursement compliance in line with HIPAA and