Under the direction of the Manager, Coding Compliance, the OP Coding Compliance Auditor will play a key role in reviewing and analyzing retrospective claims for coding compliance. This role will be responsible for reviewing and accurately auditing office, hospital, and surgical procedures for coding compliance. The OP Coding Compliance Auditor will also be committed to ensuring accurate and compliant medical coding and auditing for both inpatient and outpatient services, diagnostic tests, and other medical services rendered to patients.
Essential Functions and Responsibilities of the Job
Proficient in Microsoft Office suite
Proficient in Epic software
Strong analytical skills with the ability to identify opportunities in documentation improvement
Strong critical thinking and problem-solving skills
Excellent written, oral, and interpersonal communication skills with the ability to communicate information accurately and clearly
The ability to provide excellent customer service and provider support
The ability to set priorities and meet strict deadlines without issue
The ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams
The ability to perform coding audits via manual process (natively code) or audit software tool
Strong work ethic, honest, and dependable
Collaborative team player with the ability to work independently
Professional demeanor and appearance at all times
Maintain strict patient and department confidentiality
Maintain a safe and orderly work area
Interact in a positive and constructive manner
Strong time management skills – the ability to organize, prioritize, and multitask
Ability to be at work and be on time
Follow company and department policies, procedures, and directives
Essential Job Outcomes
Employ strong understanding of federal, state, and payor specific guidelines and regulations pertaining to coding, billing, and medical record documentation.
In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS code to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines.
Achievement of productivity and quality standards as established by management.
In adherence with standard work, conduct multi-specialty medical record audits for compliance with federal/state coding guidelines and regulations, and prepare automated reports of audit findings to present to providers.
In adherence with standard work, meet with MCMF providers to deliver ongoing education, support, and training to maximize coding compliance and reimbursement.
In adherence with standard work, follow Coding Compliance department standards and branding when communicating with clinical partners and fellow business center teams. Work collaboratively to solve billing and coding issues with Physician Billing Services Insurance and Customer Service Representatives.
Employ strong understanding of the encounter/billing process and working knowledge of Medicare, Commercial, and HMO insurance, including the impact on reimbursement. Utilize medical reference resources and contacts to thoroughly research coding issues and maintain working knowledge of payment/reimbursement systems to ensure maximum reimbursement and coding compliance.
In adherence with standard work, identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs. Optimization opportunities include, but are not limited to, work in the Follow-Up and Claim Edit work queues and analyzing denial trends.
In adherence with standard work, take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
Provide support and serve as a back-up to the Coding Compliance Auditor/Educator, as needed.
“Other duties as assigned”
Minimum 3-years’ experience working in a hospital or physician’s office as a medical coder/auditor and interacting with physicians;
Expert knowledge of ICD10, CPT and HCPCS
Strong knowledge of medical terminology, anatomy and physiology
Epic software experience required
Strong computer skills, including MS Office Suite
High School diploma or GED required;
CPC, CCS or equivalent certification required;
Auditing credential highly desired
Internal Number: MEM003502
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.