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Coding Auditor Technical

Silver Spring, MD

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Coding Auditor Technical

The Technical Coding Auditor will demonstrate expertise in hospital services coding and billing compliance. The Technical Coding Auditor audits to determine billing integrity of technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed. 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, DRG assignment, APC/EAPG assignment, medical necessity of the services, reimbursement overpayments and underpayments, and compliance with other documentation, coding and billing standards. The Technical Coding Auditor applies standardized audit scoring methodology to consistently evaluate documentation and coding, and standardized audit findings methodology to report audit results. The Technical Coding Auditor will also serve as a subject matter expert for technical fee billing coding and assist in provider coding education as necessary.
Minimum Education
Associate's Degree

Specific Requirements and Preferences
5 years of coding experience in lieu of the degree requirement will be considered. .

Minimum Work Experience
4 years

Specific Requirements and Preferences
4 Years as a Certified Coder in the hospital billing environment with at least 1 year of experience performing hospital billing coding audits.Minimum of 4 years of hospital coding/billing experience with pediatric coding experience strongly preferred. Additionally at least 1 year of hospital billing audit experience is required with academic medical experience preferred. Strong interventional radiology and cardiology coding experience with CIRCC credential is highly desired, but not required. Experience with electronic medical records is essential. .

Required Certifications
Certification in Coding required.
CCS, CIC, CPC, CPC- H, or COC. CPMA and/or CEMA/C preferred.
Required Skills/Knowledge
* Interpret and apply documentation and coding rules and regulations along with hospital charge capture and
reimbursement methodologies;
* Plan, conduct and perform hospital billing audits;
* Work cooperatively with Medical Center administrative staff and department staff;
* Manage diverse and conflicting priorities and projects effectively and meet deadlines;
* Maintain competence in and up-to-date knowledge of healthcare billing and coding compliance requirements, practices
and trends;
* Conduct detailed hospital billing audits, reach independent decisions and logical conclusions and prepare report of
* Interpret medical records progress notes, hand written and electronic chart entries, provider orders, and other related
* 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.
* Performs scheduled and unscheduled independent hospital billing audits of hospital documentation, coding and medical
necessity related to inpatient and outpatient billing.
* Conducts routine retrospective and prospective hospital billing audits, specialized and focused audits, and other audits as
directed by the Director of Revenue Integrity.
* Evaluates the appropriateness and medical necessity of services and procedures billed based on supporting documentation.
* Evaluates the appropriateness of ICD-10, HCPCS and CPT codes, APC/EAPG, DRG, and admission assignments, along with
modifier usage.
* Evaluates accuracy of supply and implant charge capture and coding based on Medical Center policies and related payor
* Makes determinations of overpayments and underpayments and performs other related analysis and evaluations.
* Adheres to the defined audit timeline and audit protocol standards.
* Assists with development of the audit schedule.
* Identifies services to be audited.
* Applies consistent and standardized billing audit methodology for sample selection, scoring and benchmarking
development and reporting of findings.
* Prepares written reports of audit findings and recommendations to Children's management and staff as appropriate.
* Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD,
DRG, APC/EAPG and CPT code utilization patterns, national normative data, CMS and PEPPER initiatives, and healthcare
industry best practices.
* Maintain knowledge of current Medicare, Medicaid and other third party payor billing and documentation requirements.
* Assist in education of hospital billing and documentation requirements.
* Assist in professional fee billing audits as required.
Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities.

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