Professional Fee Auditor

Description

The Professional Fee Auditor performs coding quality audits of professional fee services to ensure compliance, appropriateness, and accurate code assignments in accordance with CMS, payer, and regulatory guidelines. The Professional Fee Auditor provides actionable feedback and education to providers and coding staff to improve documentation, coding accuracy, and reimbursement integrity.

Requirements

•    Performs coding audits of professional fee records.  •    Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported.  •    Audits codes and professional fee services performed by providers from medical records according to ICD-9, CPT, HCPCS, and CMS guidelines.  •    Develops and coordinates education and training regarding the elements of coding such as appropriate documentation, accurate coding, and coding trends found during chart reviews. •    Meets with the providers or coders to review the audit findings and to recommend ways to improve when indicated.  •    Prepares written reports of the audit findings by provider/practice. •    Responsible for maintaining up to date knowledge of coding guidelines as they relate to professional services.

EDUCATION AND EXPERIENCE: •    Active coding credential: CPC or AHIMA coding credential •    3+ years coding experience in physician coding and physician billing

Summary

•    Working knowledge of CMS coding and documentation rules and regulations •    Able to identify and apply rules and regulations as they relate to professional service audits •    Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing •    Ability to analyze and identify opportunities in documentation improvement •    Excellent verbal and written communications skills required •    Maintain confidentiality of client and departmental information •    Knowledge of medical terminology •    Knowledge of CPT-4, ICD-10 and HCPCS coding •    Organized and detail-oriented, with proven ability to multi-task •    Ability to communicate well with others •    Professional appearance