Outpatient Facility Auditor

The Outpatient Facility Auditor is integral to maintaining coding accuracy and compliance with our standards. This role involves conducting detailed audits of coding logic within the Epic system and delivering quarterly educational sessions on code updates and rule changes. The auditor collaborates closely with the coding team, providing continuous education and feedback to enhance their performance. The ideal candidate will have extensive expertise in facility coding, denial analysis, and educational methodologies. This position is crucial for ensuring that our coding processes meet the highest standards of accuracy and compliance. Additional responsibilities may be assigned as needed.

• Key Responsibilities:
• Quarterly Education on Codes and Rule Changes:
• Deliver quarterly educational sessions on new and revised coding rules, including but not limited to CPT, ICD-10, and HCPCS codes.
• Educate on code updates and ensure accurate coding and compliance.
• Coding Logic Review and Audit within EPIC:
• Review and audit coding logic built within the EPIC system, including modifier logic, crosswalk logic, and other automated coding processes to ensure they align with current coding guidelines and payer requirements.
• Identify discrepancies, errors, or areas for improvement in coding logic and work with the relevant teams to resolve them.
• Carry out other duties as assigned by leadership.
  

Chart Audits

• Perform detailed audits on outpatient facility coders, ensuring that coding meets compliance standards and accuracy benchmarks.
• Monitor and track progress toward the goal of achieving a 95% accuracy rate in chart audits on a quarterly basis.
  
  

Denial Analysis And Coding

• Analyze denial data to identify trends or recurring issues related to coding errors or misinterpretations.
• Provide targeted educational sessions based on denial data to help coders improve accuracy and reduce the occurrence of denials related to coding.
• Collaborate with the team to develop strategies for addressing coding-related denials and improving overall coding practices.
  
  

Qualifications

Certified Coding Specialist (CCS)

Registered Health Information Technologist (RHIT) preferred

Experience

Minimum of 5 years of experience in medical coding auditing and/or coding education within a healthcare setting.

Proficiency in coding software, particularly EPIC and coding compliance standards.

Skills

Experience in denial analysis and resolution is highly preferred.

Strong understanding of medical coding guidelines, regulations, and payer requirements.

Excellent communication skills, both written and verbal, with the ability to deliver training and educational content effectively.

High attention to detail, analytical thinking, and problem-solving skills.

Ability to work independently and collaboratively in a team environment.