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The audit professional integrates medical coding principles and objectivity in the performance of coding audit activities.
Draws on ICD10CM, HCPCS, NCCI, and CMS coding expertise and industry knowledge to substantiate coding principles to determine potential billing / coding issues, and quality concerns.
Under indirect supervision, the Coding Auditor will audit the quality of all acute care outpatient work types to assure appropriateness and accuracy of Diagnoses, CPT, HCPCS, CCI edits, modifier assignment in accordance with ICD10 CM, ICD10PCS, CPT, HCPCS, CPT Assistant, Coding Clinic, Center of Medicare and Medicaid (CMS) guidelines, and National Correct Coding Initiatives (NCCI).
Essential Functions :
Participates in client system education to gain the knowledge necessary to audit client accounts in ensuring that the coding is supported by the patient's clinical documentation, coding / cdi guidelines and other regulatory standards / guidelines as appropriate.
Maintain meticulous documentation, spreadsheets, account, and claim examples of root cause issues. Performs searches of governmental, payor-
specific, hospital-specific, regulatory body, and literature rules, regulations, guidelines to identify and coding and billing requirements to make recommendations to clients.
Assist in the development and coordination of the executive summary reports, education and training client coding companion as it relates to the outcomes of the coding audit.
Meet established productivity standards for coding audits & coding certification requirements.
Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and / or regulations.
Provides excellent customer service, in an organized and efficient manner, while maintaining a positive attitude.
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.
Accepted : RHIA or RHIT and CCS or COC or CPC and CRCR
Preference : CPMA but others accepted CCS or COC, Certified Revenue Cycle Representative (CRCR) if not a CRCR must obtain within 90 days of employment.
At least three (3) years of experience directly related to the duties and responsibilities specified.
Knowledge of auditing concepts and principles
Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements
Ability to use independent judgement and to manage and impart confidential information
Ability to analyze
Strong written communication and interpersonal skills
Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
Knowledge of current and developing issues and trends in medical coding procedures requirements
Ability to clearly communicate medical information to professional practitioners and / or the general public
Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
Ability to provide guidance and training to professional and technical staff in area of expertise.
Ability to flex work schedule on an as needed basis to meet the business needs
Competent with the use of all Microsoft Office applications, including Word, Excel, and Power Point
Mercy Health is an equal opportunity employer.
We’ll also reward your hard work with :
S cheduled Weekly Hours :
Work Shift : Department :
Department : Carepoint
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability.
If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown, which is an Affirmative Action and Equal Opportunity Employer, please email recruitment mercy.
com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment mercy.com.
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