BASF

Medical Coding Auditor, Outpatient

BASF

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $61,300 - $71,000 per year

Job Level

Mid-LevelSenior

About the role

  • The Medical Coding Auditor-Outpatient is responsible for ensuring the accuracy, integrity, and compliance of medical coding practices within the organization, with a primary focus on Outpatient services.
  • Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.
  • Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.
  • Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.
  • Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards.
  • Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement.
  • Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency.
  • Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.
  • Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications.

Requirements

  • Extensive knowledge of ICD-10, CPT, and HCPCS coding systems.
  • Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements.
  • Understanding of medical terminology, anatomy, and physiology.
  • Strong analytical and problem-solving skills.
  • Excellent attention to detail and accuracy.
  • Effective communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Ability to work remotely from a home office without on-site Supervision
  • Proficiency in coding software and electronic health record (EHR) systems.
  • High school diploma or equivalent GED required.
  • Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.
  • Active certification is required. Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well.
  • At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
  • Coding for emergency care, observation, and same day surgery is preferred.
  • Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
  • Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.