The Coding Quality Auditor will be a Subject Matter Expert in Surgical CPT coding. The Auditor will have responsibility for auditing and educating both providers and coders on surgical CPT coding for the Middle Revenue Cycle Coding Services Operational Team with a focus on CPT, ICD-10-CM classification, Modifier assignment, and Official Coding Guidelines. This role will audit both acute and professional CPT code assignments. Auditor/Educator will provide key concepts for surgical CPT coding, supporting providers and coders on current regulations, coding guidelines, and payer requirements.
This role will be responsible for providing oversight to nimble coding services. The Auditor will lead key initiatives within the organization related to Quality metrics, workflow improvement, and audits, etc., to meet or exceed metrics, drive efficient coding services, and deliver performance excellence through the standardization of processes and focus primarily on ensuring best practices are followed within their respective facilities. The Coding Auditor drives continuous quality improvements and tracks, monitors, and trends performance to improve business objectives and to disrupt the status quo to exceed Service Level Agreement commitments.
Primary Responsibilities:
- Maintains and demonstrates expert knowledge of coding, coding operations, coding review of all coding staff (domestic and global), and best demonstrated coding practices
- Identifies & builds consensus for facilitation of system and process standardization, utilization of best practices, work integration, change management, issue resolution, metric development and measurement, and communication related to the key components of coding operations:
- Leverages standard processes, systems, or other vehicles to reduce waste and cost at the facility while improving SLAs, KPIs (Key Performance Indicators), metrics, and the overall client and/or patient experience
- Works collaboratively with Coding Operations to monitor day-to-day coding operations, prebill coding reviews, and prebill quality reviews
- Assists Coding Leadership with oversight of processes and initiatives designed to continuously improve coding quality and/or efficiency
- Maintains expert knowledge of coding to ensure a high level of accuracy and proficiency standards of performance are achieved to meet or exceed targets
- Effectively leads and participates in coding quality assurance/compliance activities that include action plans relevant to audit results, including remediation, education, and, when appropriate, assists in creating and monitoring corrective action plans
- Serves as the liaison between the coding operations, collaboratively bringing each unit together, including establishing, building, and maintaining cohesive relationships with the client
- Leads by example; promotes teamwork by fostering a positive, transparent, and focused working environment, which achieves maximum results
- Other duties as needed and assigned leadership, including but not limited to leading and conducting special projects. Develops project work plans, facilitates resource allocation, executes project tasks, and obtains assistance from other intra and inter-departmental resources, coder/client-facing education as required
- AAPC or AHIMA (CCS, CPC, RHIT, or RHIA) coding credential
- 5+ years of recent OP coding and/or coding reviewer role experience with working knowledge of spine, pain, ophthalmology, orthopedic, and general surgery procedures
- Knowledge of NCCI/OCE billing edits as it relates to outpatient facility and/or professional services coding and billing
- Industry Knowledge of Medicare regulations and payment policies, including OPPS
- Experience working collaboratively with Coding leadership in partnership to improve reimbursement and coding accuracy
- Proficiency with: Microsoft Excel, Word, PowerPoint, and SharePoint
- Proven excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
United States
