Coding Auditor Resume Sample
August Cartwright
536 Edison Junction,
Dallas,
TX
+1 (555) 801 3069
Work Experience
Director, Coding Auditor & Educator
05/2017
-
PRESENT
New York, NY
- Audits external vendors’ coding based on medical record reviews
- Works on additional risk adjustment audit requests (i.e. outside auditors’ requests)
- Develops and maintains an education calendar and individual continuing education and orientation record for each member of the assigned work group. Develops and conducts programs with educational materials, procedures and exercises that are task/function specific using a variety of learning and evaluation strategies for all staff
- Works in regional/system-wide teams to develop Health Information Management Systems and Services educational materials and activities, and promotes standardized practices throughout the region and/or company
- Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day
- Acts as the subject matter experts (SME) for correct coding
- Conducts coder education and training to help to ensure accurate CMS payment and to improve quality of care
Coding Auditor
09/2014
-
03/2017
New York, NY
- Conducts all activities in relation to audits: medical record review, identifies best medical record, submits all necessary paperwork, responds to all inquiries and provides expertise and support during the appeals process
- Works on additional coding audit requests (i.e. outside auditors’ requests)
- Clear understanding of all aspects of the revenue cycle from scheduling to payment collection
- Proficient research, writing and presentation skills
- Experience in public speaking and giving presentations
- Develops reports and collects and prepares data for studies involving inpatient stays for clinical evaluation purposes and financial impact and profitability, including rebill auditing and auditing of OIG targeted DRGs
- Demonstrates critical thinking skills and the ability to make decisions regarding coding standards independently
- AA or BA/BS with RHIT, CCS, CCS-P, CCA or RHIT
Inpatient Coding Auditor
03/2010
-
03/2014
San Francisco, CA
- Active member of AHIMA or AAPC Organization
- Extensive ICD-10, CPT and HCPCS coding experience
- Extensive Payor knowledge experience and prior training experience with Physicians
- Four years of direct coding education experience in Professional/Hospital services coding, or eight years of coding experience, strong analytic and presentation skills
- Experience with Microsoft tools and Flowcast reporting applications
- Interpret statistical data, create and interpret report data, and perform coding/physician trending for educational purposes
- Take direction from Coding Managers and Director
Education
Dakota State University - University Center
2005 - 2009
Bachelor's Degree in Health Information Technology
Professional Skills
- Excellent written and communication skills and strong influencing skills
- Demonstrated organizational, problem-solving, and interpersonal skills are required
- Strong communication skills - ability to train / educate providers on coding
- Experience in claims processing operations and reporting systems, including 2 years’ experience in auditing
- Time management, critical/creative thinking, communication, and problem-solving skills
- Experience outpatient coding experience
- Prior coding experience
How to write Coding Auditor Resume
Coding Auditor role is responsible for coding, interpersonal, training, analysis, insurance, medical, health, healthcare, travel, finance.
To write great resume for coding auditor job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Coding Auditor Resume
The section contact information is important in your coding auditor resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Coding Auditor Resume
The section work experience is an essential part of your coding auditor resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous coding auditor responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular coding auditor position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Coding Auditor resume experience can include:
- Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records
- Experience in hospital coding and/or auditing, as well as, education techniques and methods
- Experience reading operative reports
- Knowledge of ICD-10-CM/PCS coding, anatomy, physiology, adjudication of claims, and operational experience in hospital PAS is required
- Adapt to changing priorities in order to meet Client requirements and meet department productivity standards and deadlines
- Three to five (3-5) years of experience working as a certified coder
Education on a Coding Auditor Resume
Make sure to make education a priority on your coding auditor resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your coding auditor experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Coding Auditor Resume
When listing skills on your coding auditor resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical coding auditor skills:
- Two years prior coding experience in Behavioral Health in-patient, out-patient and facility
- High level of analytical ability and critical thinking skills
- Work independently and perform effectively in a fast-paced, high-growth, rapidly changing environment
- Computer application skills: Windows, Outlook, Word, and Excel
- Experience in coding with knowledge of Medicare risk adjustment (HCC Coding)
- Two to Three (2-3) years’ experience working as a HCC risk adjustment coding auditor
List of Typical Experience For a Coding Auditor Resume
1
Experience For Medical Coding Auditor Resume
- Audits and reviews documentation in Practice’s medical record system with new SHMG providers prior to billing to ensure accuracy and understanding of coding and documentation concepts. Coordinates final approval to release providers from this review with Senior Documentation and Coding Educator
- Maintain excellent intradepartmental communication; maintain good rapport with Practice Management and other departments and employees throughout Steward
- Assists in the management of the coding and billing auditing and monitoring program to address high risk compliance areas
- Guides coding and billing quality improvement activity across the organization
- Leads organizations in the development and implementation of measurable coding and billing quality plan objectives and results
2
Experience For Inpatient Coding Auditor Resume
- Monitors and audits coding and billing processes to ensure consistent compliance
- Association and Corporate Compliance Coding Guidelines. Assures compliance with the coding guidelines and regulatory requirements. (10%)
- Works with appropriate resources to ensure that all action items pending from internal and external audits are resolved
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management
- Educates department staff in addition to clinical employees in correct documentation processes and coding guidelines
- Provide ongoing input to the Edit Development team on claims selection criteria and new recovery concepts
- This is a virtual position with ability to work from any location n the U.S. near an Adventist Health site
- Actively assist in the appeal process for RAC and other payer denials
3
Experience For DRG Coding Auditor Resume
- Keep up-to-date on changes to significant regulatory and applicable agency standards as applicable to the associate’s domain
- Reviews, develops and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements
- Provides written audit guidance
- Participates with management in the assessment of external audit findings and responds as needed
- Attends meetings and interacts with management to resolve issues and provide advice on new programs
- Determine appeal action, prepare appeal letter follow up and identify education issues. (20%)
- Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial impact and profitability. Conducts education/training presentations of final audit findings to department staff, physicians and appropriate individuals. (20%)
- Once identified, evaluate the cases of the change or problems and takes appropriate steps to effect resolution. (10%)
- With technical direction and assistance from management, designs and implements coder education program, continuing education programs and Medical Staff education programs. Establishes and monitors performance and maintains appropriate documentation thereof. (10%)
4
Experience For Outpatient Coding Auditor Resume
- Reviews and interprets medical information, classifies that information into the appropriate payor specificgroups consisting of ICD CM ICD PCS and CPT codes for diagnoses and procedures and calculates the DRG and APC. (10%)
- Regularly informs management regarding work progress and seeks advice or consultation regarding issues or problem areas. Seeks direction from Director of Compliance for non-routine activities. Performs functions under minimal supervision. Requires critical thinking, decisive judgment
- Identifies inaccurate coding practices; prepares reports of findings and meets with providers and medical office staff to provide education and training on accurate coding practices, compliance risks, and revenue cycle efficiencies
- If the contract requires onsite review, interact with Providers and other personnel in a professional manner
- Timely communication with Team Lead is required regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues
- Review medical records to identify recovery opportunities on claims for Outpatient, Professional, and Ancillary Services
5
Experience For Coding Auditor Educator Resume
- Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings, and proposing recommendations. Oversee implementation of audit recommendations as appropriate. Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines
- Educate practices/providers on basic coding, documentation, and billing issues related to appropriately charging for, and documenting the services delivered in compliance with applicable rules and regulations
- Reviews medical records and coding to validate Outpatient billing to include Professional, Hospital, APC assignment
- Performs periodic and ongoing audits of claims to ensure accuracy of coding and billing, and sufficiency of supporting documentation
- Defends facility charging and coding practices during focused audits
- Responsible for updating SCIOmine (internal tool) with audit findings and completing audits assigned on a daily basis
- Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations
- Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines
- Maintains certifications and stays current on industry trend
6
Experience For Director, Coding Auditor & Educator Resume
- Performs audits of coding and medical record documentation against the itemized charges and UB-92/UB-04 codes assigned on government and non-government accounts to ensure all services provided are accurately reflected on the itemized statement
- Reviews all related documents, and identifies clerical, interpretation and record errors and adjusts incorrect items and/or services
- Follows up with Physicians/departments to better understand the procedures and identify if any procedures have not been reported/priced; Identify opportunities to assign a more appropriate code that results in a higher return to the Health System
- Reviews individual charge procedures related to each case, identifies correct service codes on supplies and/or services and makes corrections as needed.Identifies compliances risks and financial opportunities based on chart reviews
- Creates/updates and/or maintains charge protocol manuals for each service area reviewed. Seeks information necessary to accurately complete all aspects of the job requirements
7
Experience For Document & Coding Auditor, HD Resume
- Documents results of all special project work and provides recommendations for revenue managing opportunities and process improvement initiatives relating to special projects
- Makes ongoing observations and recommendations to prevent future billing problems and prepares reports as required by management regarding process improvement recommendations/initiatives and systemic claim processing issues
- Participates in and/or leads inter-departmental process improvement initiatives
- Liaises with hospital departments to communicate observations, seek clarification and makes recommendations for charge capture improvement
- Responds in a timely manner to requested and/or mandated charge master changes from the CDM Analyst
8
Experience For Clinical Coding Auditor Resume
- Investigates and documents any potential for new program and product development
- Adheres to established productivity standards, participates in departmental performance improvement activities and work level
- Communicates and works with all internal and external customers
- Work experience with PCs, word processing, spreadsheet, graphics, and database software applications. Proficient in payment review systems, hospital information systems, clinical record information systems, and some coding methodologies
- Excellent quantitative, analytical, interpersonal and communication skills.Understand medical records, hospital bills, insurance terms, payment methodologies and the charge master
- Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new regulations, policies and procedures.Knowledge of coding guidelines, both ICD-9-CM and CPT-4 and understands CMS (formerly HCFA) Memos and Transmittals and all ancillary department functions for the facility
- Write professional notes based on Scio Health Analytics policies using Official Coding guidelines, ICD-10 Coding Handbook, Coding Clinic and/or other recognized sources
- Develops corrective action plans to address opportunities for coding, billing and documentation improvement
- Comply with all National Audit Employee Handbook policies and procedures - Comply with HIPAA and other regulations regarding confidentiality of information
9
Experience For Risk Coding Auditor Resume
- Prepares audit reports that are issued to physicians, advanced practice clinicians, ministry leadership and other key stakeholders, as appropriate
- Following policy and procedures, perform internal audits to ensure compliant coding and documentation practices, correct use of CPT and ICD-10 codes, and determine adherence to established government and third party billing guidelines, AMA, AAP, CMS, and coding policies as necessary
- Develops training material and conducts in-services related to coding topics
- Identifies unbilled, under-billed and over-billed supplies and or services on accounts and makes necessary corrections
- Follows up with clinical departments to understand services provided and procedures performed
- Identifies compliances risks and financial opportunities based on chart reviews
- Creates/updates and/or maintains charge protocol manuals for service areas with input from interdisciplinary team members
- Makes ongoing observations and recommendations to prevent future coding and charging issues, prepares reports as required by management regarding process improvement recommendations/initiatives and coding issues
10
Experience For Coding Auditor & Educator Resume
- Liaises with other hospital departments and serves as point of contact on coding topics
- Submits recommendations for updates in the Charge Description Master (CDM) and other systems (such as EPIC) based upon audit findings and coding guidelines
- Adheres to established productivity standards, maintains coding credentials, and participates in departmental performance improvement activities and work level
- Serve as an expert of the inpatient prospective payment system DRG
- Responsible for maintaining coded data quality through ongoing quality review and assessment of inpatient records. Performs concurrent audits on accuracy of DRGs as well as on quality of medical record documentation needed for accurate coding
List of Typical Skills For a Coding Auditor Resume
1
Skills For Medical Coding Auditor Resume
- Strong quantitative, analytical, interpersonal and communication skills
- Intermediate strong organizational, interpersonal, communications skills
- Windows/Excel experience, case management documentation experience
- MS-DRG auditing or APR auditing experience
- Experience in a hospital or physician setting as a medical coder
- Acute in-patient and/or outpatient coding experience
- Extensive experience with ICD-10, CPT, and HCPCS coding systems
2
Skills For Inpatient Coding Auditor Resume
- Experience with: Excel, PowerPoint, Outlook, and Word
- Experience with encoder tools (Optum, TrueCode, 3M, Webtrat, Pricers)
- Experience with and expertise with LCD, NCD
- Effective oral and written communication required
- Work experience with PCs, MS Office products (Outlook, Word, Excel, etc.)
- Organized, professional, and self-motivated individual; Able to handle multiple projects and priorities
- Previous inpatient chart audit experience desired
3
Skills For DRG Coding Auditor Resume
- Experience is required
- Intermediate efficiently manages multiple priorities, is inquisitive, energetic, and takes initiative
- Two years provider education experience
- Abstracting: Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition
4
Skills For Outpatient Coding Auditor Resume
- Willing and able to travel for additional training and on-site reviews on an as-needed basis
- Troubleshooting / analysis / problem solving / detail-oriented
- Working knowledge with an electronic medical record environment and practice management software
- Collaborate with other departments to resolve billing problems related to coding, including those stemming from CCI edits and the outpatient code editor (OCE)
- To act as an ambassador for CHKS by providing a professional coding and auditing service
- Knowledge of Coding Procedures and Medical Terminology. Proficient on CPT, HCPCS and diagnosis coding in an ambulatory setting
- Provide a detailed rationale for every medical record review resulting in an Outpatient Findings letter, including supporting references
- Correctly interpret and utilize reference materials, including “Coding Clinic for HCPCS” and Outpatient Coding Guidelines
5
Skills For Coding Auditor Educator Resume
- Sound understanding of CMS, Medicare Advantage, Medicaid and Commercial billing practices,
- To assist CHKS staff with projects relating to clinical coding or audit
- Inspires confidence and cooperation from the managers, subordinates and customers by behaving and communicating in a professional manner at all times
- Coding or auditing physician claims
- Proficient on CPT, HCPCS and diagnosis coding in an ambulatory setting
- Knowledge of third party billing and payment requirements for third party payors including managed care benefits
- Knowledge of Medicare, Medicaid and third party payer billing and coding requirements
- Interpret statistical data, create and interpret report data, and perform physician profiling and trending
- Reviews and audits professional coding and billing from multiple departments and entities of University Health Care
6
Skills For Director, Coding Auditor & Educator Resume
- Reports on the accuracy of procedure, E&M, ICD-10 coding and billing to ensure compliance with legal and procedural policies
- Develops data and creates analysis regarding effects on revenue due to requested or mandated changes to the CDM and/or billing practices
- One of the following certifications: CPC, CCS, CRC
- Sound knowledge of ICD-9, ICD-10, CPT and HCPCS coding guidelines
- To lead and undertake clinical coding audits in line with the NHS Clinical Classification Service audit methodology and code of conduct
- Produce high quality and precise reports following all audits in a timely way
7
Skills For Document & Coding Auditor, HD Resume
- To undertake clinical coding for CHKS clients as required
- To promote CHKS as an expert and professional coding services provider and recognise potential opportunities to work further with clients
- Competency in ICD-10, HCPCS, CPT, and E/M coding
- O Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P) designation required with current active status
- Proficient in payment review systems, hospital information systems, clinical record information systems, and coding methodologies
- Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Registered Nurse (RN)
- Able to clearly articulate issues and communicate correct coding principles in a manner easily understood by a non-coder
- Familiarity with radiology and laboratory coding
- Knowledge of Coding Procedures and Medical Terminology
8
Skills For Clinical Coding Auditor Resume
- Familiar with Medical Billing
- Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist certification
- Considerable knowledge of medical records technology, coding conventions and regulatory requirements
- One of the following certifications: RHIT, CCS, CCS-P, or CPC
- One year of working with medical claims required
- Assesses and identifies training and documentation opportunities
- Comfortable working in a production based work environment
- Certified Coding Certification, or ability to acquire within 24 months of hire
9
Skills For Risk Coding Auditor Resume
- Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the charge master. (10%)
- Reviews billing and revenue cycle processes for accuracy and process improvements
- Follow CGI Federal policies and processes, completing Red Carpet, payroll, travel expense documents, and other corporate requirements in a timely manner
- Submits recommendation to make internal changes as needed to keep the facility coding and chargepractices compliant with applicable rules and regulations
- Able to obtain CPMG within first year of employment
- Intermediate knowledge of Microsoft Outlook, Microsoft Excel, Microsoft Visio, Microsoft Word, and Microsoft PowerPoint
10
Skills For Coding Auditor & Educator Resume
- Experience in a Hospital or Physician setting as a Medical Coder; 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding)
- Gaps or potential gaps in documentation are escalated for remediation, trending and reporting
- Participate in continuous improvement training and working towards an “error-free” environment
- Provide independent and critical thinking regarding data analysis
- Understand and comply with Correct Coding Initiative edits for hospital/facility outpatient encounters
- Execute quantitative analysis using Excel
- Audits each coder quarterly for quality
- AHIMA credential: RHIT, RHIA, CDIP and/or CCS required
List of Typical Responsibilities For a Coding Auditor Resume
1
Responsibilities For Medical Coding Auditor Resume
- Accountable for auditing charts and creating useful, routine reports for the physicians, coding and CDI departments
- Monitors coding for compliance with approved AHA Coding Clinic Guidelines
- Communicate to Coding leadership findings and need for directed education
- Prepare reports, identifies trends and takes appropriate actions in response
- Develop education and training for coders, clinical department and/or physicians for documentation improvement affecting reimbursement 5. Perform coding audits as a third party reviewer to enhance reimbursement
- Performs quality audit assessments for coding accuracy and compliance to coding guidelines as stated by regulatory agencies and in accordance with HCMC coding policies
- Collaborate with Coding and CDI Management, Physician liaisons and Documentations Integrity Educators to complete a continuous feedback loop based on quality documentation and coding initiatives and review findings
- Accountable for compliance audits of patient records and report findings/corrections to coders to improve consistency and accuracy
- Create consistency and efficiency in inpatient documentation, data collection and claims processing to optimize prospective payment reimbursement and facilitate data quality for inpatient and outpatient services
2
Responsibilities For Inpatient Coding Auditor Resume
- Responsible for working cross-functionally to improve documentation of patient care and to appropriately assign codes and obtain equitable prospective payment reimbursement
- Educates and queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes
- Audit post discharge pre billed accounts and codes inpatient charts as directed by Coding Inpatient Supervisor
- Provide feedback in designated manor to coders and clinical documentation staff with auditing results on weekly/monthly basis
- Analyze and track audit results on a monthly basis; Assists in producing weekly audit reports
- Audit new coder charts for accuracy and provide feedback to new coders as needed
3
Responsibilities For DRG Coding Auditor Resume
- Report and track DRG accuracy rates for coders and CDI staff, trending results and reporting on a monthly the department director, manager, Coding inpatient supervisor and others as directed
- Conduct education in-services with coding staff and clinical documentation staff at least bimonthly and more frequently when audit results indicated necessity. Utilize relevant publications, such as AHA Coding Clinics for education
- Monitor and evaluate coding staff’s compliance to the principles of ICD-10-CM/PCS coding nomenclature
- Become proficient in ICD-10-CM/PCS coding and be an available resource to coders
- Review coding differences from internal and external audits and develop and implement corrective action plan for these coding compliance variances; Perform follow up monitoring for compliance
- Work with leadership to identify education opportunities for providers (Attending, PAs, and APPs) and assist in education sessions provided by Physician Liaison educators and clinical documentation staff
- Experience in E & M coding required
- Experience coding 25 modifier
- Audits focus on chart analysis and coding data
4
Responsibilities For Outpatient Coding Auditor Resume
- Ensures that providers have the understanding and tools necessary for appropriate evaluation & management, procedure and diagnosis documentation
- Review the coding of the 25 modifier to determine if modifier was applied appropriately
- Provide written rationale for decision if coding is incorrect
- Identify potential risk areas and provides appropriate possible recommended solutions
- Is responsible for education of all physician and midlevel providers regarding coding compliance standards set forth by Federal or State, accrediting bodies and third party requirements
- Prepares audit reports that are issued to key stakeholders, as appropriate
- Review physician medical records to determine if the evaluation and management service was coded at the correct level of intensity
5
Responsibilities For Coding Auditor Educator Resume
- Works in conjunction with other departments to include appeals, claims, and Corr PRT
- Analyzes data to identify patterns and development of interventions at the provider and market level to coordinate an educational work plan for WellCare contracted providers
- Collects data and analyzes to find billing pattern aberrancies or anomalies, and to drive audit case selection
- Identifies inaccurate coding and billing practices; prepares reports of findings and meets with providers and medical office staff to provide education and training on accurate coding practices, compliance risks, and revenue cycle efficiencies
- Collaborates with managers and supervisors to provide workflow recommendations for efficiency and accuracy
- Educates department staff in addition to clinical employees in correct documentation processes, billing practices and coding guidelines based on federal guidelines and accepted societal publications
- Capacity to work independently in a virtual office setting or in clinic setting if required to travel for assignment
- Develops audit detail summary spreadsheets and reports to address any coding, documentation, financial impact and profitability. Conducts education/training or works with external resources to present final audit findings to department staff, physicians and appropriate individuals. (20%)
6
Responsibilities For Director, Coding Auditor & Educator Resume
- Validates the ICD CM, ICD PCS, CPT and HCPCS Level II code and modifier systems, missed secondary diagnoses and procedures and ensures compliance with DRG/APC structure and regulatory requirements. Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster. (10%)
- Reviews and interprets medical information, classifies that information into the appropriate payor specific groups consisting of ICD CM ICD PCS and CPT codes for diagnoses and procedures and calculates the DRG and APC. (10%)
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Corporate Compliance Coding Guidelines. Assures compliance with the coding guidelines and regulatory requirements. (10%)
- Reviewing physician reports and determine if appropriate Evaluation and Management (E/M) code and/or CPT along with HCPCS Level II, ICD-9-CM/ICD-10-CM codes, and modifiers
- Four years of coding experience in a hospital setting required
- Providing feedback to physicians regarding coding and documentation through audit findings
- Audits patient records for accuracy in ICD-10-CM coding, CPT/HCPCS coding and APC assignment and other coding/billing data elements
7
Responsibilities For Document & Coding Auditor, HD Resume
- Assists in the management of coding and billing auditing and monitoring program to address high risk compliance areas
- Enters audit information into the company spreadsheet, ensuring the accuracy and integrity of the medical record data abstracted or encounter data corrected, prior to submitting the data
- Working knowledge of CPT, HCPCS, ICD-9-CM/ICD-10-CM, Prospective Payment Systems, Correct Coding Initiative, Third Party Liability
- Extensive knowledge of coding and processing of Government claims – specifically Medicare, Medical and Workers Compensation
- Provide educational feedback to the coders via the coding manager regarding record review outcomes
- Reports and tracks DRG accuracy rates for coders, trending results and reporting on a monthly basis to the department director
- Ensures timely data completion by meeting audit productivity/quality standards established for the Professional Auditor
- Ensure all external regulations affecting the coding process are implemented in the work course to assure compliance and consistency of coding and reduce the risk of external audits
- Prepares and presents educational programs related to coding
8
Responsibilities For Clinical Coding Auditor Resume
- CCS-P, CCS, or CPC certification required from AHIMA or AAPC
- Applies AHA Coding Clinics, AHA Coding Clinics for HCPCS, CPT Assistant, ICD-10-CM Official Guidelines for Coding and Reporting, and CMS regulatory guidance related to coding/billing data elements and hospital OPPS reporting
- Participates in continuing education for maintenance of coding credentials
- Collaborates with other stakeholders such as HIIM and PFS/Revenue Integrity leadership during the audit process
- Prepares, maintains and distributes audit documentation and reports
- Maintains quality and productivity levels set forth by leadership
- Keeps abreast of regulatory and industry changes
- Identifies trends and educational opportunities
- Maintain a complete understanding of the internal corporate coding guidelines and federal coding guidelines relative to provider documentation of services rendered in the procedural and diagnostic coding of those services
9
Responsibilities For Risk Coding Auditor Resume
- Conduct focused coding audits as requested
- Reviews codes/code sets that are triggered for technical service review to determine appropriateness in billing
- Maintains credentials through continuing education and professional development
- Prepare audit reports as directed
- Audits plan parameter set up, performs periodic and ongoing audits for claims to ensure accuracy of coding and billing, and sufficiency of supporting documentation
- Experience in health care or hospital operations
- Assists supervisor with various outside audits including SOC audit
10
Responsibilities For Coding Auditor & Educator Resume
- Analyzes and tracks audit results on a monthly basis; produces audit results reports and submits to department supervisor and manager
- Conducts education in-services with coding staff quarterly and more frequently when audit results indicate necessity. Utilizes relevant publications, such as AHA, Coding Clinics for education
- Monitors and evaluates the compliance of coding staff adhering to the principles of ICD-10-CM/PCS and CPT coding nomenclature. Overall coding accuracy >/= 95%
- Communicates to Coding leadership findings and need for directed education
- Identifies potential risk areas and provides appropriate possible recommended solutions
- Medical codingcertification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) required
- CPMA or equivalent experience required; CPC/ CPMA required within 12 months of hire
- Knowledge of classification systems, including CPT, E&M, ICD-10, and HCPCS nomenclature, coding rules and guidelines, coding conventions established by the American Medical Association, the Center for Medicare and Medicaid, and AAPC for assignment of diagnostic and procedural codes required
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