BayCare Clinic · 3 weeks ago
Coding Compliance Auditor
Green Bay, WI
Full-time
Hybrid
Mid Level
3+ years expBayCare Clinic is a physician-owned entity that provides specialty medical services. They are seeking a Coding Compliance Auditor to conduct comprehensive coding audits, evaluate service validity, and analyze coding issues to enhance claim submission accuracy.
Health CareHospitalMedical
Responsibilities
Conducts comprehensive coding audits including but not limited to the review of: pre-bill and post-bill charges; coder-focused and provider-focused audit samples; and random and focused samples
Evaluates the validity of services, procedures, diagnoses, and drugs/supplies billed based on the supporting documentation
Analyzes the results of internal and external audits for patterns and identifies opportunities for coder education and provider documentation feedback
Analyzes coding issues that generate claim edits and insurance denials
Assists in creating and maintaining department resources
Prepares formal reports of audit results and denial feedback
Make recommendations for Epic warnings and rules to maximize claim submission accuracy
Stays current with official coding guidelines for CPT, HCPCS, and ICD-10-CM and CMS NCCI edits and policy
Maintains thorough knowledge of payor reimbursement policies
Complies and adheres to pertinent policies and procedures
Respects and maintains confidentiality
Works in a safe, compliant and ethical manner at all times
Performs any and all other assigned responsibilities
Qualification
Required
Coding certification specific to outpatient professional coding required
3+ years of recent experience in specialty professional coding required
Advanced knowledge of ICD-10-CM, CPT and HCPCS coding required
Exceptional written and verbal communication skills
Proficiency in Microsoft Office (Outlook, Teams, Excel, Word) required
High degree of focus with exceptional attention to detail
Advanced ability to identify coding quality issues
Ability to work independently and exercise independent judgment and decision making
Preferred
A minimum of an Associate's degree in Health Information Technology or equivalent is preferred
Certified professional Medical Auditor (CPMA) preferred
1+ years of recent experience in a coding auditing role preferred
Experience with Epic EMR and/or web-based coding software and/or medical coding audit software preferred
Benefits
Health, dental, disability and life insurance
Flexible spending options
401k retirement plan with a company match
Generous PTO
Paid holidays
Company
BayCare Clinic
BayCare Clinic offers anesthesia, cardiology, vascular surgery, sports medicine, neuropsychology, radiology, and orthopedics services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ashwani Bhatia. MD,CPE,FACP
Chief Executive Officer
Julie Duckett
Chief Financial Officer
Recent News
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