US:NV:Carson City Health Information Management Full Time Standard Office Hours Summary The Non-Clinical Coding Auditor and Trainer reviews services provided and compares them to EHR and billing records to determine accuracy. This position is responsible for performing quality reviews of outpatient medical records to validate the integrity of ICD-10 diagnoses and procedures as well as CPT/CPT II/PCS coded procedures.
The position reviews medical records and other documentation to identify under and over coded services, prepares reports of findings and meets with management to educate on and improve coding practices. The Coding Auditor and Trainer ensures appropriate coding and maintains compliance documentation. This position ensures that billing is optimized, and errors are minimized by identifying opportunities through audit and observation; remaining abreast of regulatory and procedure changes which may affect coding compliance and /or reimbursement.
Qualifications Required One of the following active credentials: AHIMA CCS AHIMA RHIT AHIMA RHIA AAPC or equivalent Preferred Five (5) years coding/auditing experience
Audit Carson Tahoe provider’s medical records and charges to ensure compliance with coding standards. Reports on the accuracy of CPT and ICD-10 coding to ensure compliance with payer, legal and procedural policies and regulatory guidelines. Educate Carson Tahoe providers and coders to appropriate coding, reimbursement and documentation as required by medical review and regulatory requirements.
Document effective auditing and compliance program including standards of conduct with respect to ethical billing practices. Participates in the development and application of written policies promoting Carson Tahoe’s commitment to Compliance and addressing specific areas of potential fraud. Conduct periodic meetings with Carson Tahoe providers to include: Chart reviews Coding reviews for over/under coding patterns Coding patterns in general and in specific Revenue enhancement opportunities Address over coding and/or under coding issues individually with Carson Tahoe providers.
Work closely with HIM and Coding leadership to complete new provider audits, including documentation review during first month and audit of charges to ensure coding accuracy. Provide education to Providers and coders as necessary regarding updates coding/billing changes. Participate in special audits as instructed.
Performs other related duties as assigned. Ad hoc projects as assigned.