Certified Professional Medical Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess the precision, consistency, and quality of coded medical records produced by both internal and external coding personnel.

• Perform routine monthly, retrospective, concurrent, and targeted audits of coding.

• Review ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and modifier codes through audits.

• Analyze coding accuracy, completeness, consistency, and adherence to guidelines and organizational standards.

• Confirm code assignment and sequencing based on documentation provided by providers.

• Address routine coding inquiries and escalate more complicated or unclear issues as needed.

• Detect coding errors, trends, compliance issues, revenue concerns, and opportunities for process enhancement.

• Track coding quality metrics and aid in the development and reporting of scorecards.

• Offer timely, constructive, and personalized feedback to coders.

• Recognize educational and developmental needs and contribute to coding education sessions.

• Develop tip sheets, coding guidance documents, case studies, and training resources.

• Assist in the onboarding and mentoring process for newly hired coders.

• Support corrective action plans and individualized education strategies.

• Act as a coding resource and assist with complex coding inquiries.

• Stay informed about regulatory and coding guideline changes and communicate their implications.

• Help with internal and external coding quality assessments.

• Analyze audit findings and create reports that include findings and supporting documentation.

• Monitor coder performance improvements and evaluate educational effectiveness.

• Suggest workflow enhancements and standardization of processes.

• Collaborate with the Coding Manager and Coding Leads on auditing, education, and coder development initiatives.

• Participate in the development of coding policies and procedures.

• Utilize approved AI tools to enhance productivity, accuracy, and decision-making.

• Carry out other related duties as assigned.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• An Associate's or Bachelor's degree in Health Information Management or a related healthcare field is preferred.

• Current Certified Professional Medical Auditor (CPMA) certification is required.

• One of the following AAPC or AHIMA certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), RHIT, or RHIA.

• At least 3 years of medical coding experience in professional and/or facility coding is necessary.

• A minimum of 1 year of experience in coding quality review, auditing, or education is required.

• Capability to operate under general guidance and exercise sound judgment on coding matters.

• Extensive knowledge of ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and official coding guidelines.

• Strong grasp of coding quality methodologies and auditing principles.

• W2 project-based consultants must provide a computing device that meets industry standards and security best practices.

• Demonstrated productivity, responsiveness, and dependability in a remote working setting.

• Ability to make sound, independent judgments on ambiguous or complex coding issues.

• Objectivity and consistency in the evaluation of others' work.

• Clear and constructive communication skills.

• Ability to remain current and adaptable as coding guidelines and regulations evolve.

• Strong attention to detail and capability for trend-level thinking.

• Proficiency in managing competing priorities and deadlines.

• Patience and a constructive mindset when coaching and developing others.

• Strong sense of ownership and commitment to follow through.

🏝️ Benefits

• A variety of health and dental plans with nationally recognized networks.

• Vision benefits included.

• Comprehensive wellness program.

• Employee assistance program available for employees and their families.

• Retirement savings plans offered.

• Company-paid disability and life insurance provided.

• Pre-tax savings opportunities (HSA and/or FSA) available.

• Opportunities for professional development.

• Options for remote work.

• Generous paid-time-off policy.

• Flexible scheduling accommodations.