Coding Auditor - Educator

November 20

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Highmark Health

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health care

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Description

• Performs all related internal, concurrent, prospective and retrospective coding audit activities. • Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments. • Reports findings both verbally and in writing and communicates results to affected areas. • Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. • Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. • Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching plans in accordance with federal and state regulations and guidelines.

Requirements

• Minimum High school diploma / GED • Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) • In-depth knowledge of ICD CM, ICD PCS and CPT/HCPCS coding systems • Must be proficient in DRG/APC structure, National Correct Coding Initiatives, ICD CM/PCS Official Guidelines, Outpatient Prospective payment system and Coding Clinic references • Current working knowledge of encoder, grouper, abstracting and other related software • Strong analytical and communication skills • Preferred Associate's Degree • 3 years with claims processing and data management • Past auditing and strong education/training background in coding and reimbursement