Coding Auditor

Job Details
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  • Minimum 5 years’ experience in healthcare coding/auditing (E&M, CPT, HCPCS and ICD-10).
  • Required: Certified Professional Coder (CPC) or other similar certification.
  • Experience with HIPAA, data privacy, and/or data security processes.
  • Experience working with regulators governing (public or private) health insurance carriers.

Full Job Description

Coker Group is seeking to hire a professional coding auditor and trainer to provide consultative assistance to our healthcare clientele. The ideal candidate would be responsible for conducting audits to assess compliance with documentation, coding and billing guidelines, providing training to clients based upon audit findings, and conducting quality assurance on other auditors as required.

We are looking for a highly organized, detail-oriented individual, who is comfortable working in a fast-paced and rapidly changing environment with a proven ability to identify billing and coding issues, and a proficiency in evaluating how well clinical documentation supports medical decision-making and billing guidelines. This position will work independently under limited supervision with emphasis on initiative and independent judgment. Some travel required.

Education and/or experience: Associates degree or equivalent experience as a coder/auditor is required. A certificate in coding through the American Academy of Professional Coders (AAPC) or other equivalent program certificate is required. CPMA or equivalent is a plus. Certification as ICD-10 trainer preferred and/or experience with ICD-10 and hierarchical condition coding (HCC).

Knowledge: A good working knowledge of healthcare practices, operations and physician coding compliance. Specifically, a good working knowledge of medical terminology, patient care services, and clinical documentation. Become and/or maintain expert knowledge of government regulatory processes/rules.

Skills: Proficient with Microsoft Office tools including Outlook, Excel, Word, PowerPoint and SharePoint. Audit skills with the ability to interpret and apply Federal and State regulations, coding and billing requirements. Provide feedback constructively and with sensitivity. Demonstrated critical thinking skills and ability to resolve complex coding issues through root cause analysis.

Abilities: Possess strong written and oral communication skills. Demonstrate interpersonal skills to interact appropriately with various levels of management, mid-level providers and physicians. Ability to self-direct and attentive to details. Proven ability to learn basic auditing skills and working knowledge of healthcare billing while identifying coding trends, risk areas and training opportunities. Must take advantage of available information technology during the audit process. Ability to work and maintain a high degree of confidentiality and integrity.

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