Professional Coding Auditor

Emory Healthcare•Tucker, GA

10h

About The Position

This position ensures the accuracy, completeness, and compliance of medical coding and documentation for professional coding services. This role involves reviewing patient records, clinical documentation, and coded data to identify discrepancies and ensure adherence to coding guidelines. By working closely with healthcare providers, coders, and compliance teams, the auditor supports accurate professional coding, optimizing reimbursement, and mitigating compliance risks. Key responsibilities include conducting comprehensive chart reviews, evaluating provider documentation accuracy, and participating in regular audits to maintain high standards of coding accuracy and compliance. The role may involve providing training to healthcare professionals, analyzing coding data, and generating audit reports.

Requirements

Candidates should have a high school diploma or equivalent; Two years post-secondary education in a business or medical related field preferred. Two years of experience in a medical billing/coding office; medical management experience preferred, OR any other combination of relevant education and/or experience.
Candidates should have a coding certification through a nationally recognized organization (AAPC, AHIMA, etc.) required: CCS-P, CPC, RHIA, RHIT, CCS, CPC-H).
Candidates should have strong knowledge of medical terminology, anatomy, and coding systems.
Candidates should have strong written and verbal communication skills.
A thorough understanding of healthcare regulations and excellent attention to detail are essential.

Nice To Haves

Preferred experience includes previous work in medical coding, auditing, or chart review within a healthcare setting, and familiarity with electronic health records (EHR) systems.

Responsibilities

Audit and Review: - Conduct regular audits of medical coding to verify accuracy, completeness, and compliance with ICD-10, CPT, HCPCS, and other relevant coding systems. - Evaluate coding practices against payer guidelines, regulatory requirements, and internal policies.
Compliance Monitoring: - Ensure adherence to federal and state regulations, including CMS guidelines and HIPAA standards. - Identify and report any discrepancies or violations and recommend corrective actions.
Reporting and Documentation: - Prepare detailed audit reports highlighting findings, trends, and recommendations for improvement. - Document audit procedures, results, and any issues identified in a clear and concise manner.
Stay Current: - Keep up-to-date with changes in coding guidelines, healthcare regulations, and industry best practices. - Attend relevant workshops, seminars, and continuing education courses as required.