Coding Auditor

JOB SUMMARY: Perform audits of medical documentation, claims and other operational materials to ensure compliance with Medicare, Medicaid and other payer requirements. Contributes expertise to the development of training for Kaiser clinicians and coders. Maintains and supports a culture of compliance, ethics and integrity.  Responsible for ensuring ongoing auditing and monitoring of compliance for the function of coding.  Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to Coding and medical billing.  This position is responsible for consistently maintaining high quality results toward organizational goals and objectives pertinent to provider coding, billing and documentation requirements.

 

POSITION REQUIREMENTS: At least 4 years experience in medical insurance, diagnostic & procedure coding, and/or medical billing, auditing, third party payer regulations to include reimbursement experience in Medicare, Medicaid, and third party liability billing required. At least 1 year of experience in auditing medical record documentation required. Must hold at least one of the following credentials: CCS, CCS-P, CPC, CPC-H or RHIA.  Expert knowledge of ICD-9-CM, CPT and HCPCS classification systems.  Familiarity with DRG, APC and other reimbursement methodologies.  Successful completion of internal assessment test required.  Demonstrated ability to interact in a collaborative manner with multiple departments. Demonstrated ability to understand the clinical content of a health record including the most complicated records. Demonstrated ability and experience in preparing chart note audits, medical documentation training and in preparation of instructional materials for training. Excellent written, communication and presentation skills with the ability to explain, and write complex information in a clear, concise, and organized format. Ability to communicate with physicians and non-physician staff with a commitment to provide quality customer service.  Demonstrated expert level of knowledge of anatomy and physiology, medical terminology, disease process, reimbursement methodologies, and conventions, rules, guidelines for current coding classification. Ability to analyze data needs and software support systems for the claims and audit processes. Ability to analyze audit results to determine root cause and recommendations for improvement of workflow and business practices. Excellent time and project management skills. Ability to write reports summarizing audit findings and recommendations. Proficient in statistics, spreadsheet and work processing applications.

Prefer working knowledge of outpatient/inpatient physician service delivery and of the electronic medical record system. Must maintain all certifications required by the position.