Coding & Quality Auditor

Facility: VIRTUAL-GA

Job Summary:

The Coding & Quality Auditor is responsible for discovering, assessing, and monitoring clinical documentation and billing practices to ensure correct coding practices are being followed and that there has been a complete capture of all documented charges. The team member will assess all MGBO coding staff with continuous monthly monitoring applying proficient coding skills that are maintained via internal policies and external regulatory policies by appropriate governing bodies. The team member will be responsible for researching, training, and reporting any concerns that are found during routine and ad hoc auditing to the team members and management.

Core Responsibilities and Essential Functions:

Key Role/Responsibility - Job Functions

• Perform 20 prospective, concurrent, and retrospective audits per team member monthly.
• Review and assess coded medical records and prepare spreadsheets for review with staff and management.
• Analyze report findings that identify common issue, including over-coding, under-coding, and missed billing opportunities.
• Prepare reports, summaries, and examples of audit findings for presentation and educational purposes.
• Research Billing and coding guidelines from all third-party insurance companies including CMS, commercial, etc.
• Respond to coding inquiries that are received from internal departments.
• Develop training materials for webinars and present training monthly.
• Back up to charge coding staff when short staffed or volume is abnormally high.
• Provide ad-hoc reports as requested.
• Provide training/corrective recommendations for staff with continuous low-quality output.
• Special projects related to job functions.

Key Role/Responsibility - Professional Development

• Maintain all professional certifications.
• Continuously learning about new coding concepts and billing rules with the expectation that auditors attend webinars, conferences, and read periodicals related to their job functions to stay abreast of technology and code changes.
• Maintain knowledge of all multispecialty assignments.
• Attend WellStar learning courses for Microsoft Office products (Excel, Word, PowerPoint).

Performs other duties as assigned. Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

College Degree (AS/BS) Required

Required Minimum License(s) and Certification(s):

• Cert Coding Spec - Phys Based or Cert Prof Coder or Reg Health Information Admin or Reg Health Information Tech

Additional License(s) and Certification(s):

CPMA Upon Hire Preferred and CPC-I Upon Hire Preferred

Required Minimum Experience:

• Minimum 3 years of coding experience Required or Minimum 5 years of coding experience. Required
• Minimum 3 years of coding and auditing experience Required or Minimum 5 years of coding experience. Required
• Candidate should possess multi-specialty coding experience with a minimum of one year training experience. Required
• Experience in fraud, waste, and abuse. Required
• Epic and 3M experience Preferred

Required Minimum Skills:

Knowledge of auditing coding for E&M, CPT codes, diagnosis codes, procedure codes, modifiers, and billing rules/edits. Comprehensive knowledge of CMS requirements, claims processing, commercial insurance billing/coding guidelines, and the Revenue Cycle process. Extensive knowledge with medical billing software and electronic medical records. Proficient PC skills, including Microsoft 365. Ability to communicate with various members of the healthcare team. Ability to use EXCEL, Word and have basic computer operational knowledge.