|Required Experience:||1 to 2 years
|Preferred Experience:||3 to 4 years
|Location:||Maryland Heights, MO
Position Summary:The Medical Coding Auditor will work with our Coding Manager to perform both internal and external audits. Actively involved in auditing all functions and services related to medical coding, medical documentation, and physician queries. Monitors coding and abstracting quality by conducting ongoing audits to ensure coding quality and performance improvement standards are maintained, achieved and improved. Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures.
Roles & Responsibilities:
- The Auditor will interpret medical information such as diseases, conditions, or symptoms, and diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD-10-CM
- Validate provider diagnosis coding for accuracy by reviewing of coding documentation and claims extract compared to actual medical records
- Review and identify trends in coding discrepancies and notify applicable department for potential training and education
- Determine coding issues and discrepancies and make updates as necessary
- Reviews coded patient charts, utilizing the medical charts (both paper and electronic) and previously applied codes and compares both to ensure accuracy, while making written notes of findings and communicating those findings with leadership.
- May be required to notify team members directly and individually via e-mail or telephone of instances where serious deficiencies necessitate focused reviews.
- Discusses with the Coding Manager issues/questions/problems which may arise.
- Maintain acceptable levels of attendance and punctuality as specified in company and departmental policies.
- Meet routine deadlines and work schedules as well as timely and accurate completion of special projects and any other duties as assigned.
- Understand, support, enforce and comply with company policies, procedures and Standards of Business Ethics and Conduct.
- Display a positive attitude as well as professional, polite, considerate and courteous conduct and treatment of others in the course of duties.
- Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.
- Provides verbal and written reports of the results of coding audits, to include
recommendations for corrective action and improved accuracy.
- Provide coverage for other compliance disciplines and complete other duties as assigned.
- Some travel to other markets may be required
Experience, Qualifications and Education:
- High school diploma or general educational degree (GED)
- Associate’s degree or Bachelor’s degree strongly preferred
- Must have Medical coding certification through either AAPC or AHIMA
- Must obtain an AAPC Certified Risk Adjustment Coder certification within 12 months of employment
- 3+ years’ experience working in medical coding/auditing with experience in ICD-10-CM HCC diagnosis coding
- Strong research skills including knowledge of automated analysis tools and on line research tools required to resolve complex coding/systems issues
- Proficient with business applications like Microsoft Office, Adobe, etc
- Experience working with Electronic Medical Record systems like Epic, Cerner, etc strongly preferred
- Ability to work independently in a fast-paced environment with competing priorities
- Demonstrated ability to communicate effectively through both written and verbal modalities
*Please note, this is an on-site position at our headquarters in Maryland Heights, Missouri. After 3-4 months, employees may have the ability to work remotely.
Lumeris is an EEO/AA employer M/F/V/D.