Certified Coding and Billing Auditor- Medicine

Performs functions such as reviewing documentation and selecting the appropriate procedure and / or diagnosis code to be entered in billing documents. Ensures that teaching physician requirements are met and are clearly reflected in the documentation. Retrieves and audits medical records to determine if billing reflects the care documented, and identify areas of exposure and revenue enhancement based on CMS rules and regulations. Provides education based on findings. Acts as Liaison with Patient Accounting department. Investigates and then educates regarding the cause of denials, if coder/charge entry related. Requires Certification. Multi-specialty knowledge and experience preferred. EDUCATION and/or EXPERIENCE Bachelor's degree (B.A. / B.S.) from four-year college or university preferred Must have CPC or CCS-P coding certification Five or more years experience in professional coding and/or auditing; clinical background strongly preferred Equivalent combination of education and experience may be substituted for degree Extensive knowledge of CPT and ICD-10 coding Knowledge of government regulations as they relate to teaching physician documentation and billing guidelines Knowledge of CMS rules and regulations Understanding of: the importance of compliance with all government, department, and contractual regulations regarding coding and billing; and provider requirements Knowledge of medical terminology, anatomy, and physiology

Created: 2024-10-24