Professional Billing Quality Coding Auditor, FT, Days, - Remote

Inspire health. Serve with compassion. Be the difference.

Job Summary

Performs routine and specialty reviews of coders to ensure accurate coding. Prepares a summary of findings and presents reports to leadership on a monthly basis. Assists with training coders on identified opportunities for improvement. Assists in preventing coding denials.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:  Inspire health.  Serve with compassion.  Be the difference.

• Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings.

• Performs review of all coders within the department and prepares a summary of findings.

• Provides training to coders on identified issues found during reviews.

• Codes charges for professional billing based on review of clinical documentation.

• Identifies and assists with the resolution of coding issues and process improvement.

• Assists in creating edits to prevent denials.

• Assists in creating a standardized process for front end coding including the development of training materials.

• Mentors and trains coders on correct coding guidelines.

• Interacts with other departments to assist in resolving coding.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - Bachelor's degree in Business or related field of study

• Experience - Three (3) years multi-specialty coding experience in professional billing

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• CPC Certified Professional Coder (AAPC) and

• CPMA Certified Professional Medical Auditor (AAPC)

Knowledge, Skills and Abilities

• Knowledge of medical terminology and basic anatomy and physiology with the ability to apply coding concepts to ensure correct coding.

• Analytical skills.

• Working knowledge of Epic, Encoder Pro, 3M

• Ability to work independently and manage multiple projects consistently

• Proficient computer skills (word processing, spreadsheets, database)

• Data entry skills

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7001 Corporate

Department

70019178 Medical Group Coding & Education Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.