Medical Coding Auditor

Medical Coding Auditor
Bethesda MD
MUST:
Experienced Medical Coding Auditor
Must have coding auditing credential - CPMA. Cert. Professional Medical Auditor
CPC or CPMA or CCS preferred
High School Diploma required
Orthopedic experience is a must
Neuro Therapy experience
DUTIES:
Audit medical records to ensure compliance with the organizations coding procedures and standards.
Review insurance payments and denials and recommends billing corrections
Review and research medical records to determine the accuracy of coding, billing, and supporting clinical documentation
Review medical records that have been reviewed and coded by the coding vendor
Reviews and research billed unlisted procedure codes to determine if a more specific code exists and should be used.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies as necessary or required.
Effectively communicates with providers to clarify diagnoses, procedure coding and documentation requirements, including proper sequencing
Reviews assigned ICD-10-CM codes, which most accurately describe each documented diagnosis and/ or procedure according to established ICD-10-CM and CPT-4 coding guidelines along with modifier usage and medical terminology
Monitors all coding accuracy at various levels of detail and maintains coding quality as needed.
Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement. Reports or resolves escalated issues as necessary
Performs a comprehensive medical records review to assure the presence of all component parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
Monitors, audits, and reconciles all documents required for data entry, returns incomplete or questionable documents to generating location or provider
Provides a high level of technical education and serves as a subject matter specialist regarding coding and documentation
*Quadrant, Inc. is an equal opportunity and affirmative action employer. Quadrant is committed to administering all employment and personnel actions on the basis of merit and free of discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or status as an individual with a disability. Consistent with this commitment, we are dedicated to the employment and advancement of qualified minorities, women, individuals with disabilities, protected veterans, persons of all ethnic backgrounds and religions according to their abilities.