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Form of workPosition Summary:
The Coding Auditor/Coding Specialist is responsible for reviewing and auditing to ensure compliance and accuracy. Knowledge of best practices for chart documentation compliance and auditing required. This position will also complete standard medical coding duties, such as, charge entry, reviewing and verifying codes are entered at the proper level, and correcting any coding errors. Effective communication, both written and oral, working under pressure, meeting deadlines, and making decisions using sound judgement are essential to this role.
Essential Functions:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ensures coding and documentation are in compliance with the national guidelines from CMS and Sound Family Medicine’s standards and protocols.
- Performs chart audits and reviews; Reviews charges and documentation for compliance meeting national requirements and Sound Family Medicine protocols; Initiates correction as needed.
- Maintains current knowledge on coding compliance and provides suggestions to the Business Office Manager regarding improvements to protocols and processes; Stays current on best practices and changes related to coding and chart auditing compliance.
- Review provider coding of services provided for medical claims
- Reviews reimbursement from third-party payers to ensure payment through proper use of codes in coordination with the Business office Manager.
- Works with medical staff to resolve coding issues and associated problems.
- Monitors Medicare reimbursements and maintains files. Assures information is available for peer and Medicare review in coordination with the Business Office Manager.
- Act as the liaison between providers, staff, and outside parties on coding issues
- Correct and resubmit claims based on review of the records, provider input, and payer input in coordination with the Business Office Manager.
Competencies/Skills:
- Teamwork: Works together to achieve our goals, collaborating to achieve success and respecting our differences as people.
- Communication: Keeps coworkers and management informed and openly offers information in an effective manner. Communicates in a manner that can be understood, both in writing and orally. Can easily be approached by patients, coworkers and managers. Interactively listens and seeks clarification when necessary. Demonstrates effective interpersonal skills, including diplomacy and conflict resolution, and is flexible when dealing with other people and work styles.
- Decision Making/Problem Solving: Able to identify existing or potential problems, gather relevant information, and analyze the information to identify possible causes of problems. Applies knowledge, experience, and common sense and considers alternatives when deciding on the best potential solutions.
- Job Knowledge: Demonstrates clear and thorough knowledge of responsibilities, understands the components of the job and how their job affects their department and the company.
- Dependability: Demonstrates consistent reliability in the work that they produce and the behaviors they display and how it affects the larger picture.
- Productivity: Utilizes time management skills to prioritize tasks based on level of importance and produce the expected volume of work without jeopardizing quality.
- Caring: Treating our patients and our employees with compassionate care, always trying to do what’s best for each individual, for our patient community, and workplace as a whole.
- Patient Focused: Providing the best family medical care to our patients.
- Intentional: Making decisions and behave in a way that ensures the desired outcome is most likely.
- Integrity: Striving to be open and honest and hold ourselves to the highest standards of ethics, honesty, and transparency in everything we do.
Supervisory Responsibilities:
This position does not have any supervisory responsibilities.
Work Environment:
This position will work in a typical office environment with a moderate noise level. This role will use standard office equipment such as computers, phones, copiers, filing cabinets, and fax machines.
Physical Demands:
Reasonable accommodations may be made to enable individual with disabilities to perform he physical requirements of this position.
Reasonable accommodations may be made to enable individual with disabilities to perform he physical requirements of this position.
This position is primarily a sedentary role; however, this position need to file, communicate over the phone and in-person, and use standard office equipment. May be required to lift up to 10 pounds.
Travel:
Minimal local travel may be required for this position.
Education and Experience:
- Education:
- High School Diploma or Equivalent: Required
- Certified Professional Coder (CPC) Certification or Certified Professional Medical Auditor (CPMA) Certification: Required
- Experience:
- 2+ years’ experience auditioning medical charts and coding: Required
- Intermediate to advanced Excel skills
Other Duties:
This is not a comprehensive list of all duties, responsibilities, or activities that may be required for this position. Position requirements including duties, responsibilities, or activities may change at any time, with or without notice.
Sound Family Medicine is a smoke-free, drug-free workplace. All employment offers are conditioned upon acceptable pre-employment drug tests which include testing for the use of marijuana and nicotine. As part of our commitment to a healthy workplace, we require employees to obtain an annual flu immunization as well as all employees be fully vaccinated for COVID-19 by October 18, 2021.
