Senior Quality Auditor

Description

 The Coding audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed including ICD-10/CPT/HCPCS and other third-party payor codes medical necessity of the services. The Coding Auditor applies standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to report audit results. 

Qualifications

 Minimum Education
associate degree Candidates with 3 years of coding experience in lieu of the degree requirement will be considered. .

Minimum Work Experience
4-5 years as a Certified Coder preferably with experience in EM/Denial/Surgery coding and/or experience performing coding audits.

Required Skills/Knowledge
Interpret and apply documentation and coding rules and Plan, conduct and perform coding audits
Conduct detailed coding audits, reach independent decisions and logical conclusions and prepare report of findings;
Interpret medical records progress notes, hand written and electronic chart entries, provider orders, and other related documentation;
Proficiency in the use of personal computers with Windows operating systems including Microsoft applications such as Word, Excel, Outlook, PowerPoint and Access.
Communicate effectively both verbally and in writing.

Required Licenses and Certifications
CCS, CIC, CPC, CPC- H, or COC. (Required)

Roles & Responsibilities:

• Provide timely quality follow through in the form of audits and development sessions
• Develop and maintain a repository of internal monitoring results & feedback to identify trends and target improvements
• Ensure communication with Quality Analysts exists while passing new information to team members & support the team in developing/maintaining initiatives geared towards quality improvement
• Support the Service Excellence quality unit by identifying new initiatives to include expanding the quality program scope and maintenance of processing models, guidelines and scoring methodologies
• Performs other work related duties as assigned