Medical Coding Auditor, Outpatient
BASF
Clinician Services Analyst Senior - Medical Specialties
Advocate Aurora Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Wisconsin
Visit company websiteSalary
💰 $38 - $56 per hour
Job Level
Senior
About the role
- Monitor and analyze KPIs to identify trends and transform data into actionable reports and presentations that support strategic decision-making.
- Collaborate with leadership and cross-functional teams—including Coding, CDI, CMD, Quality, and Clinical Informatics—to identify improvement opportunities and advance documentation practices.
- Provide operational and technical guidance to staff and stakeholders, ensuring clarity and consistency in documentation and coding processes.
- Review clinical documentation and diagnostic results to ensure accurate assignment of ICD-10-CM/PCS and CPT/HCPCS codes in alignment with organizational initiatives.
- Query providers when documentation is unclear, following established policies to ensure coding accuracy and compliance.
- Demonstrate compliance with regulatory requirements, including CMS, QIOs, NCCI edits, and payer-specific guidelines, while adhering to AHIMA’s Standards of Ethical Coding.
- Utilize EHR systems and coding tools proficiently, maintaining data integrity and supporting efficient documentation workflows.
- Maintain confidentiality of patient records and report any non-compliant practices to appropriate leadership or compliance officers.
- Engage in continuous learning, staying current with evolving coding guidelines, practices, and terminology through training and professional development.
- Promote a collaborative, service-oriented culture, modeling professionalism and teamwork across Clinician Services and organizational stakeholders.
Requirements
- RHIA or HIT or CCS or CCS-P or CPC; Specialty credential required within one year of employment
- Education Required: Completion of advanced training in revenue cycle management through a recognized or accredited program, equivalent in scope and rigor to post-secondary education. High school diploma or GED required.
- Experience Required: 5 years of experience in expert-level professional and/or facility coding, and experience in collaborating with other teams within an organization, and/or educating/training licensed clinicians.
- Advanced level of ICD-10-CM/PCS and/or ICD-10-CM/CPT/HCPCS for a large complex health care system or medical group.
- Knowledge, Skills & Abilities Required: Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage determinants, research-related restrictions, ICD-10 CM/PCS, and CPT/HCPCS coding classifications.
- Proficiency in statistical analysis is essential to examine revenue cycle/reimbursement activities and identify and address related issues.
- Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, etc.) or similar products and in patient accounting and billing systems.
- Ability to deal and work effectively with multiple departments and in matrix organizational structures.
- Proven ability to influence others not directly reporting to them.
- Strong negotiating skills.
- Strong oral and written communication skills.
- Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment.
- Highly proficient in problem-solving and analytical thinking with strong attention to detail.
- Advanced knowledge of Epic and other reporting tools to analyze data, generate reports, and optimize workflow efficiencies
