Professional Medical Auditor
Full-time (100%/40 hours per week)
Monday through Friday, 8am to 5pm
Adena Regional Medical Center, 272 Hospital Road, Chillicothe, OH 45601
1: This is not a remote coding
opportunity. The ideal candidate will
reside within a reasonable commuting distance.
2: The position may be available in a
remote setting upon completion of coding competency and 95% percent coding
accuracy audit rate.
This position performs professional
coding and abstracting functions of professional fee encounters for providers
in our multi-specialty group. The coder
assigns appropriate CPT, ICD-10 and HCPCS code based on reading the
documentation present in the medical record.
The coder will apply their knowledge of correct coding guidelines as
appropriate for professional services performed in the outpatient and inpatient
setting. The coder will apply
appropriate CPT modifiers for professional coding to call CPT codes as
necessary. Reviews medical records for
diagnoses that meet medical necessity according to the CMS Local Coverage
Determination (LCD) and/or National Coverage Determination (NCD) guidelines. Provides guidance and support for clinics to
ensure compliant coding and documentation practices are followed in accordance
with CMS rules and regulations.
Recognizes when it is necessary to obtain further clarification from
providers when documentation is inadequate or unclear for coding purposes. Works directly with the billing department to
prevent denials and ensure revenue integrity. Provides support for providers to
ensure charge capture of CMS quality payment incentive programs. This position may be available in a remote
setting upon completion of coding competency and 90% coding accuracy audit
thorough understanding of Cardiology ICD, CPT, HCPCS, utilize and apply all
applicable modifier coding rules, EM coding and auditing as well as medical terminology
and physician coding reimbursement.
proficiency as an educational resource to others in sharing knowledge and
providing direction within the scope of the job maintaining a comprehensive and
current level of knowledge of new developments and issues related to coding and
reimbursement in the healthcare environment.
organizational skills with ability to meet timelines.
Ability to work
independently as well as with a team.
Must be able to
proactively and appropriately communicate with specialty providers to clarify
diagnosis and procedures.
documentation to insure accurate ICD, CPT, HCPCS code assignment and
appropriate reimbursement in accordance with all coding, Medicare/Medicaid and
other payer specific guidelines for specialty.
reviews all data collected, identifying all coding and documentation errors,
including working payer denial reports and ensure corrective action is taken.
successfully pass basic coding competency testing and quarterly QA audits.
education and maintaining of annual CEU’s and Certifications in assigned
Position Specific Knowledge, Skills and
medical terminology and Anatomy & Physiology, ICD, CPT and HCPCS codes and basic
prioritize work to meet timelines.
Cardiology and Cardiovascular coding, billing and documentation.
Diploma or GED
Current CPC –
Certified Professional Coder; CPC-A – Certified Professional Coder Apprentice
status through AAPC – American Academy of Professional Coders; OR CCS –
Certified Coding Specialist; CCS-P – Certified Coding Specialist Physician
based or RHIT – Registered Health Information Technician through AHIMA –
American Health Information Management Association.
certifications in designated specialty specific area
3-5 years of
experience coding in the assigned specialty area (example: CIRCC, CPMA, CCCS,
HCC coding experience
Experience with Microsoft Word, Excel
3-4 years of experience in Auditing