Senior Claims Auditor
Risk Strategies Company
Coding Quality Auditor
Cleveland Clinic
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Assess the accuracy and completeness of inpatient and outpatient medical record documentation through the conduct of random and focused coding audits.
- Document findings, prepare and present audit results and perform investigations to provide comprehensive feedback.
- Serve as a subject matter expert in coding, offering guidance and support to ensure compliance with established coding standards, regulatory requirements and organizational best practices.
- Provide feedback on the application of coding guidelines, practices, proper documentation techniques, data quality improvements and revenue enhancement opportunities.
- Perform retrospective and concurrent audits in accordance with coding guidelines to ensure coding accuracy and proper reporting.
- Prepare and present reports for pre-bill and retrospective coding audits directly to Providers and coding staff.
- Analyze coded data to identify areas of risk and provide recommendations for documentation improvement.
- Assist in the development of programs and procedures to improve coding accuracy rates.
- Interact with Providers and coding staff to resolve documentation or coding issues.
Requirements
- High School Diploma and five years of professional coding experience OR Associate’s Degree and four years of professional coding experience OR Bachelor’s Degree and three years of professional coding experience
- ONE of the following certifications is REQUIRED and must be maintained: RHIA, RHIT, CCS, CCS-P, CIC or CPC
- Proficient in Microsoft Office Applications (e.g., Word, Excel)
- In depth knowledge of ICD-10-CM/PCS coding principles, CPT coding principles, DRG assignment, APC assignment and modifier assignment
- Knowledge of human anatomy and physiological disease processes
- Knowledge of medical terminology
- Knowledge of auditing concepts and principles
- Coding assessment relevant to the work may be required
Benefits
- Health insurance
- Paid time off
- Professional development
- Wellness programs
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
coding auditsICD-10-CM codingICD-10-PCS codingCPT codingDRG assignmentAPC assignmentmodifier assignmentauditing conceptsdocumentation improvementdata quality improvements
Soft skills
communicationpresentationanalytical thinkingproblem-solvinginterpersonal skillsguidancesupportfeedbackcollaborationinvestigation
Certifications
RHIARHITCCSCCS-PCICCPC
