Job Summary:

The Coding Auditor / Analyst is responsible for auditing, coaching, advising and providing feedback to coders and practitioners on coding and documentation to ensure that TVC provides sufficient refunds and complies with relevant standards and regulations. Role supports compliance with all third party payment and refund conditions, including but not limited to the provisions of the Medicare and Medicaid programs. Serves as an authority on programming for coders and providers.

Responsibilities:

Conduct inspections using an in-depth knowledge ofICD-10, CPT and HCPCS coding, Correct Coding Initiatives (CCI) and instruction papers.
Provides instruction for all new coders and, where appropriate, if coding problems are found or new procedures are introduced.
Provides day-to-day help to coders reacting for programming and documentation related questions.
Provides coding and information instruction and learning through the participation of the provider unit meetings.
Conduct programming tests of coders and suppliers on the basis of areas of deficiency.
Provides, if required, ad hoc inspections of coders and/or suppliers.
Support the development and recording of coding policies and procedures.
Using comprehension of the Practice Management System to propose improvements to the Master File to enable the proper coding of claims by carrier type.
Analyzes charge analysis of coding-related editing and denial patterns to find areas where additional training or program improvement is needed.
Through partnership with Medical Affairs Coding Enforcement, the on-going dissemination of information to Providers, Coders and Clinic Managers to advise coding policy through email, memos and periodic meetings.
Keeps the Coding / Pay Capture Director up to date with the issues that arise.
Participates in programs to improve coding and pay clinical-wide entry functions
Performs other related tasks as assigned.

Qualifications:

A high school diploma or equivalent is required.
Must have and retain one of the following coding requirements: AHIMA (CCA, CCS, CCS-P, or RHIT); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the related AAPC specialty coding requirements).
At least two years of CPT, ICD-10 coding systems and chart auditing training have been recommended.
Certified Professional Medical Auditor (CPMA) requires, or is able to obtain, within one year of employment.
Practice in the environment of a medical office required, with a demonstrated understanding of standard insurance refund methodologies preferred.
Experience educating physicians regarding coding, charting and other relevant processes, in an individual and group setting preferred.
Knowledge of medical terminology, physiology and ancillary tests / procedures.
Excellent organizational skills and good attention to detail needed.
Good verbal skills for presentation.
Must have demonstrated expertise with computer systems, including electronic health records, provided by Microsoft Office Suite.
Valid Driver's license, insurance, and access to the vehicle required.
Typing skill of 40 wpm.
Working knowledge ofICD-10,CPT, and HCPCS coding and Correct Coding Initiatives (CCI)