Medical Coding Auditor – Inpatient, OIG Focus
Job Description:
• Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.
• Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.
• Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.
• Provide training and support to coding staff on best practices, coding updates, and compliance standards.
• Prepare detailed audit reports that highlight findings, trends, and areas for improvement.
• Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.
Requirements:
• High school diploma or equivalent GED required.
• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.
• Active certification is required.
• Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well.
• At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
• Coding for emergency care, observation, and same day surgery is preferred.
• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.
Benefits:
• medical
• dental
• vision
• HSA/FSA options
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually
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• Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.
• Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.
• Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.
• Provide training and support to coding staff on best practices, coding updates, and compliance standards.
• Prepare detailed audit reports that highlight findings, trends, and areas for improvement.
• Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.
Requirements:
• High school diploma or equivalent GED required.
• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.
• Active certification is required.
• Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well.
• At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
• Coding for emergency care, observation, and same day surgery is preferred.
• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.
Benefits:
• medical
• dental
• vision
• HSA/FSA options
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually
Apply tot his job
Apply To this Job