Outpatient Coding Auditor & Educator

CGH Medical Center; Sterling (IL); On-site; USD 27,000 - 40,000; Full time

Benefits offered by this job

Health and dental Insurance

IMRF retirement

401A/457 plans

Flexible Spending Account

Life Insurance

Short/Long Term Disability

Paid Time Off

Tuition Reimbursement

Discounts (pharmacy, vision)

Employee Assistance Program

Loan Forgiveness

Day Care Discount

Gift Shop Discount

CGH Pharmacy Discount

CGH Day Care Discount

Job summary

CGH Medical Center seeks an Outpatient Physician Coding Specialist to perform prospective and retrospective coding reviews and audits, educate clinicians, and ensure compliant coding for surgical procedures and E/M services.

You will collaborate with physicians and staff, review denied claims, and support clean claim submission while maintaining up-to-date knowledge of regulatory guidelines.

Qualifications

• 2 years of experience working in a medical center doing billing, coding, or reimbursement with Medicare, Medicaid and insurance required.
• CPC, CCA, CCS, CCS-P, RHIA or RHIT preferred
• CPC must be completed within 2 years of hire.
• Knowledge of CPT and ICD-9 diagnosis coding and modifiers; regulatory requirements highly valued.
• Computer literacy with standard software

Responsibilities

• Perform Prospective and Retrospective coding reviews of surgical procedure documentation; verify codes, place of service, and modifiers.
• Audit practitioner E/M coding against medical records and educate clinicians on guidelines.
• Meet with physicians and staff to train on coding workflows and software usage.
• Review commercial claims failing the scrubber audit; correct and resubmit as needed.
• Research payor claim denials due to coding issues and prepare appeals when appropriate.
• Prepare facility charges and post CPT/ICD-10 codes for various services.

Skills

Billing & Coding

Regulatory knowledge

Computer literacy

Education

CPC/CCA/CCS/CCS-P/RHIA/RHIT preferred

CPC within 2 years of hire

Tools

Billing software

Job description

CGH Medical Center seeks an Outpatient Physician Coding Specialist to perform prospective and retrospective coding reviews and audits, educate clinicians, and ensure compliant coding for surgical procedures and E/M services.

You will collaborate with physicians and staff, review denied claims, and support clean claim submission while maintaining up-to-date knowledge of regulatory guidelines.