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Huron · 1 day ago

Coding Auditor – Ambulatory/Professional Coding/Profee

Chicago, IL

Full-time

Onsite

Mid Level

$26.44/hr - $36.06/hr

3+ years exp

Huron is a company that helps healthcare organizations drive growth and enhance performance. They are seeking a Coding Auditor to ensure coding accuracy standards are met by auditing coders and coding auditors, while maintaining effective communication with client teams and payers.

ConsultingInformation TechnologyProfessional Services

No H1B

Responsibilities

Knows, understands, incorporates, and demonstrates Huron’s Vision, and Values in behaviors, practices, and decisions

Responsible for the auditing of coders and/or “audit the auditors” to ensure coding accuracy of a minimum of 95% is met

Perform quality checks/audits on visits coded as per client SOPs

Perform calibration audits

Suggest improvements and schedule calibration sessions with offshore team counterparts and leaders

May assist in preparing audit reports, share direct feedback to coders and auditors on areas of opportunity, participate in client interactions and internal stakeholder meetings

Firm understanding of the clinical documentation guidelines

Monitor compliance of coding guidelines and ensure errors are identified during audits are corrected as appropriate, and corrective action is initiated before the claim is rebilled to the insurance

Conduct analysis and present summary of findings to leadership in a clear, concise, convincing, and actionable format

Utilizes encoder software applications, which includes all applicable online tools and references

Assigns appropriate code(s) by utilizing coding guidelines established by: The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Guidelines for Coding and Reporting, American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification, The American Medical Association (AMA) for CPT codes and CPT Assistant, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Client coding procedures and guidelines

Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes

Meets the productivity standards for coding auditing - as per the productivity norms specific to ambulatory coding standards

Maintains a high degree of professional and ethical standards

Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences

Maintains CEUs as appropriate for coding credentials as required by credentialing associations

Maintains current knowledge of changes in ambulatory/professional coding/profee coding and reimbursement guidelines and regulations

Ensure patient information is correct and appropriate signatures are on all medical records

Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation

Utilizes EMR communication tools to track missing documentation or ambulatory queries that require follow-up to facilitate coding in a timely fashion

Works with HIM and Patient Financial Services (PFS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement

Identifies, and attempts to problem solve, coding and/or EMR workflow issues that can impact coding

Exhibits awareness of health record documentation or other coding ethics concerns

Notifies appropriate leadership for assistance, resolution when appropriate

Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior

My require abstracting of additional data elements

Perform other duties as assigned

Qualification

CPC CertificationCoding AuditingEncoder SoftwareClinical Documentation GuidelinesMicrosoft Office SuiteAnalytical SkillsRevenue Cycle KnowledgeCommunication SkillsAttention to DetailTime ManagementTeam CollaborationAdaptability

Required

Current permanent United States Work Authorization required

Working in the United States Day shift schedule required

Experience in coding specialties such as E&M, Oncology, Acute, Ambulatory, Cardiology, Radiology, Pathology, Anesthesia, Emergency Room, Surgery, and others

2+ years previous experience as a professional/profee/ambulatory coding auditor

3+ years of experience coding professional/profee/ambulatory accounts

Advanced proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint)

Analytical skills (problem solving, quantitative, workflow process, etc.)

Ability to pay close attention to details; strong follow-up and follow-through skills

Excellent time management skills; organized; ability to prioritize completing multiple tasks on schedule in a deadline driven environment

Requires the use of independent judgement, discretion and decision-making abilities

Ability to interact with internal and external customers in a professional manner

Ability to ramp up on a client's environment, processes, historical context, and systems to provide support to an engagement as soon as possible

Financial acumen and analytical skills are required

Strong oral and written communication skills, analytical skills, ability to work independently, and be self-motivated are required

Flexible and adaptable to change

Coding Auditor - Responsible for the auditing of coders and/or “audit the auditors” to ensure coding accuracy of a minimum of 95% is met