Coding Quality Auditor
Children's Healthcare of Atlanta
Outpatient Auditor I, Healthcare
EXL
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Junior
About the role
- Review outpatient medical records to ensure compliance with regulatory requirements, payer guidelines, and organizational policies
- Conduct thorough CPT/APC coding reviews to verify the accuracy of the CPT coding assignment and APC reimbursement
- Apply knowledge of Medicare, NCCI and other coding guidelines to a variety of claim scenarios and utilize industry and proprietary tools to maximize overpayment identifications
- Document audit results using AHA Coding Clinic Guidelines and CPT coding rules and guidelines
- Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, Optum Encoder) efficiently and accurately to make audit determinations and generate audit rationales
- Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals
- Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements
- Comply with all EXL policies and procedures including HIPAA and other state and federal regulations
Requirements
- Required one or more of the following credentials: CCS, RHIA, RHIT, CPC
- Associates degree or 1 year of experience
- Knowledge of coding guidelines
- Knowledge of CPT coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance, NCCI coding guidelines coupled with APC payment methodologies including Medicare Outpatient Prospective Payment System (OPPS)
- Experience with encoder tools (3M, Webstrat, Optum Encoder)
- Works independently in a remote environment and delivers exceptional results during EXL core business hours
- Possesses excellent time management and work prioritization skills
- Takes ownership of problem solving
- Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail
- Proficient in Excel, Word, and OneNote with general computer literacy
- Passionate about Outpatient Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support
