Opelousas General Health System · 1 day ago
Revenue Cycle Auditor - Credentialed Coder
Opelousas, LA
Full-time
Onsite
Senior Level, Lead/Staff
10+ years expOpelousas General Health System is seeking a Revenue Cycle Auditor – Credentialed Coder responsible for auditing professional and facility claims to ensure accurate coding and billing. This role collaborates with revenue cycle leadership and clinical providers to improve documentation quality and reimbursement accuracy.
Health CareHospitalService Industry
Responsibilities
Perform prospective and retrospective audits of medical records and associated charges to validate code selection, modifiers, medical necessity, and documentation sufficiency across inpatient, outpatient, ED, and professional services
Evaluate claims against NCCI/CCI edits, MUEs, payer bulletins, and internal policy; document findings and corrective actions to ensure regulatory and payer compliance
Conduct focused and random provider audits (including multi specialty) and maintain defensible audit workpapers, scoring, and feedback summaries
Coordinate audit response process including all RAC audits, CERT Reviews and DRG-related downcodes or recoupments
Analyze denial trends related to coding, medical necessity, bundling, modifier usage and collaborate with coding, billing, and clinical teams to implement preventive edits and workflow improvements
Support appeal strategy by drafting or refining coding based appeal rationales and by supplying documentation evidence aligned to payer guidelines
Develop and deliver education for coders, billers, providers, and residents on compliant documentation and coding, emerging code set updates, and payer policy changes
Provide one on one and group feedback sessions, translating audit results into practical job aids, tip sheets, and specialty specific guidance
Partner with IT and revenue cycle teams to optimize edits, charge capture, and reconciliation processes; contribute to policy and procedure updates that enhance accuracy and throughput
Track and report KPIs (accuracy rate, denial rate, appeal overturns, audit completion cadence, education impact) and recommend continuous improvement initiatives
Qualification
Required
Active CPC® (AAPC) or equivalent coding credential (e.g., CCS, CCS P, COC); commitment to ongoing CEUs
10+ years of broad coding/auditing experience spanning inpatient, outpatient, emergency department, and professional services; demonstrated competency in multispecialty environments (e.g., cardiology, OB/GYN, pediatrics and pediatric subspecialties, neurology, nephrology, GI, pulmonary, critical care, urology, behavioral health)
Proficiency with ICD 10 CM/PCS, CPT®, HCPCS Level II, NCCI/CCI edits, MUEs, medical necessity standards, and payer policy interpretation
Proven experience auditing claims, resolving denials, preparing appeals, and educating providers/coding staff
Preferred
Familiarity with Cerner, E Clinical Works, Epic or similar EHR/PM/coding tools; proficiency with Microsoft Word, Excel, and PowerPoint
Exposure to charge reconciliation, posting reviews, and collaboration with revenue integrity/IT for edit design and workflow optimization
Company
Opelousas General Health System
Opelousas General Health System is a 286-bed full service medical center.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ginger Mouton, RHIA, CHC
Chief Compliance & Privacy Officer
Tim Marks
Chief Population Health & Clinical Integration Officer
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