McLaren Health Care Coding Auditor Professional in Shelby Township, Michigan
Responsible for completing quality assurance audits on professional coding specialists, onboarding audits and training of newly hired coding specialists, validating the coding specialist is accurately abstracting data into medical record systems, following the Official ICD-10-CM coding guidelines and relevant federal regulations using current CPT-4, HCPCS II, and ICD-10 CM materials, the Federal Register, CMS and other pertinent materials.
Optimizes prospective payment reimbursement and facilitates data quality by creating consistency and efficiency in physician documentation, code assignment, data collection, and claims processing.
Responsible for working with physicians, coders, ancillary department staff, CDI, and other allied health professionals to improve documentation of patient care and to appropriately assign codes and/or determine charges to support those services.
Essential Functions and Responsibilities :
Performs retrospective, random and focused audits of coding cases to ensure accurate code application and overall coding quality of select primary and specialty care E&M and procedural charges to ensure correct coding, legal compliance and complete charge capture.
Using CPT-4 and ICD-10, HCPCS II, provider documentation and other approved resources, evaluates the proper assignment of procedure, modifier and diagnosis codes to professional services in order to validate accuracy and compliance.
Reports quality results, tracking and trending of educational opportunities of the coding specialist and provides educational support and training.
Maintains consistent coding auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.
Gather, transfer and analyze all auditing results to capture and demonstrate risk issues, revenue leakage and educational opportunities.
Associates degree in HIT or related healthcare field.
One year E&M coding/auditing experience in any medical specialty.
Three years experience in surgical and outpatient procedural coding is required.
RHIT (Registered Health Information Technician (AHIMA), CCS (Certified Coding Specialist (AHIMA), or CPC, CCS-P or PCS coding credential required
- Prior Audit Experience
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Job: Non-Health Professional
Primary Location: Michigan-Shelby Township-McL Central Bus Office
Organization MHC00-McLaren Health Care
Employee Status Regular
Shift Day Job
Job Type Standard
Req ID: 20009127