Coding Auditor (CPC or CCS-P)

Location: Cerritos, CA
Date Posted: 06-29-2018
Healthcare Coding Auditor (CPC or CCS-P) – Managed Care
Cerritos, CA 
Your Job Summary:
The Coding Auditor performs coding audit activities by evaluating medical records and validating that appropriate clinical diagnosis and procedure codes are assigned by coding consultants and contracted client organizations in accordance with nationally recognized coding guidelines.  The coder provides coding expertise as well as administrative oversight to ensure successful integration of initiatives.  Performs chart documentation audits, educates staff on current coding practices, assures that all compliance standards are met, and performs adhoc projects as requested by the Director.
Your Background:
Requires either Certified Coding Specialist-Physician (CCS-P) or Certified Professional Coder (CPC).
Around 1-2 years of a variety of coding experience, including INPATIENT and OUTPATIENT, at a minimum.
Knowledge of ICD-10 and CPT/HCPCS and additional coding categories/types is required.  
At least 1 year of Musculoskeletal procedural and surgical coding experience is required.
Possess medical knowledge, skills and abilities to identify non-compliance in areas of coding practices and medical record documentation.
Able to work independently with a high degree of attention to detail and reliable decision-making abilities.
Computer skills necessary to provide accurate medical record reviews and any corresponding documentation of results through remote access.
Ability to maintain a standard minimum number of reviews per week.
Position Description:
  • Conducts quality assurance audits for all consultant coding reviewers and their related activities. 
  • Reviews and analyzes medical information from medical records against billed procedures to ensure accurate coding of diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements.
  • Performs a detailed review of the inpatient medical record to validate each line was coded with the appropriate diagnosis, procedure, and revenue code and that the ICD-9/ICD-10 diagnosis and procedure codes were coded and sequenced correctly to achieve the appropriate MS-DRG, AP-DRG, or APR-DRG.
  • Makes corrections as needed to ensure accurate billing and reimbursement processing; providing written justification for use by client organizations to adjust claims.
  • Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes.
  • Evaluate the quality and consistency of medical record reviews and write a well-reasoned finding’s rationale for each provider letter, with a professional writing manner.
  • For all assigned records assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. 
  • Prepare reports of findings and share with the Managers and assist the Managers in providing feedback and remediation to reviewers.

480.425.2451 (CALL – TEXT – FAX)
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