Coding Auditor – Ambulatory, Professional Coding, Profee

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

📋 Description

• Conduct audits on coders and/or auditors to ensure adherence to a minimum coding accuracy standard of 95%.

• Execute quality checks and audits on visits in accordance with client Standard Operating Procedures (SOPs).

• Carry out calibration audits.

• Recommend enhancements and coordinate calibration sessions with counterparts and leaders in offshore teams.

• Assist in the preparation of audit reports and provide direct feedback to coders and auditors.

• Engage in interactions with clients and participate in internal stakeholder meetings.

• Apply clinical documentation guidelines and oversee compliance with coding standards.

• Detect coding errors, ensure necessary corrections, and implement corrective actions prior to rebilling claims.

• Analyze and communicate findings to leadership in a clear, concise, compelling, and actionable manner.

• Utilize encoder software applications along with relevant online tools and resources.

• Assign the appropriate diagnosis and procedure codes following CDC, CMS, AHA, AMA, AHIMA, and client-specific coding guidelines.

• Navigate patient health records and electronic systems to ascertain accurate diagnosis and procedure codes.

• Achieve productivity benchmarks for ambulatory coding audits.

• Maintain coding skills, knowledge, accuracy, Continuing Education Units (CEUs), and stay updated on coding and reimbursement changes.

• Validate that patient information and medical record signatures are accurate.

• Employ compliant coder query practices with physicians, Clinical Documentation Specialists (CDS), and other healthcare providers.

• Monitor and track missing documentation and ambulatory queries using EMR communication tools.

• Collaborate with Health Information Management (HIM) and Patient Financial Services (PFS) teams to address billing, claims, denial, and appeal issues.

• Identify and resolve coding and EMR workflow challenges that impact coding.

• Inform leadership about any concerns related to health record documentation or coding ethics.

• Ensure compliance with relevant federal, state, and local laws, regulations, coding ethics, policies, and procedures.

• Abstract additional data elements as necessary.

• Perform additional duties as assigned.

⛳️ Requirements

• Permanent Work Authorization in the United States is required.

• Must be available for a Day shift schedule in the United States.

• Experience in coding specialties such as E&M, Oncology, Acute, Ambulatory, Cardiology, Radiology, Pathology, Anesthesia, Emergency Room, Surgery, and others is essential.

• Minimum of 2 years of prior experience as a professional/profee/ambulatory coding auditor.

• At least 3 years of experience in coding professional/profee/ambulatory accounts.

• Advanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook, Visio, SharePoint) is required.

• Possess strong analytical skills (problem-solving, quantitative analysis, workflow processes, etc.).

• Strong attention to detail with excellent follow-up and follow-through abilities.

• Outstanding time management skills; well-organized; capable of prioritizing multiple tasks to meet deadlines in a fast-paced environment.

• Requires independent judgment, discretion, and decision-making skills.

• Ability to professionally interact with both internal and external customers.

• Quick adaptation to a client’s environment, processes, historical context, and systems to provide immediate support.

• Financial acumen and analytical skills are necessary.

• Preferred experience working with data from diverse sources.

• Familiarity with revenue cycle systems and a deep understanding of the revenue cycle process flow and financial analysis.

• A strong desire to work collaboratively as part of a team in a partnership role.

• Excellent oral and written communication skills, analytical skills, and ability to work independently while being self-motivated are essential.

• Must be flexible and adaptable to change.

• Certification as a Professional Coder (CPC) through AAPC is required.

• AAPC CPMA (Certified Professional Medical Auditor) certification is preferred.

• Registered Health Information Administrator (RHIA) certification is preferred.

• Experience with encoder software (3M/Solventum, Encoder Pro, Codify) is preferred.

• Familiarity with Epic, Cerner, and Meditech systems is preferred.

• Ability to remain seated at a desk/computer for 8 hours daily and utilize a computer keyboard, mouse, and monitors.

• Occasionally required to lift up to 20 pounds and to bend and stand for short periods.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Additional wellness programs.

• Eligibility to participate in Huron’s benefit plans.