Medical Coding Auditor-Outpatient (OIG Focus) Clearance required

About the position The Medical Coding Auditor-Outpatient - (OIG Focus) is responsible for ensuring the accuracy, integrity, and compliance of medical coding practices within the organization, with a primary focus on Outpatient services. This role involves auditing medical records, coding data, and billing information to verify adherence to coding guidelines and regulations. The Medical Coding Auditor plays a crucial role in minimizing coding errors, preventing fraudulent activities, and ensuring that the organization meets all applicable standards and requirements.

Responsibilities

• Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.
• Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.
• Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.
• Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards. Conduct workshops and seminars as needed.
• Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement. Present reports to management and relevant stakeholders.
• Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency.
• Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.
• Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications.

Requirements

• Extensive knowledge of ICD-10, CPT, and HCPCS coding systems.
• Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements.
• Understanding of medical terminology, anatomy, and physiology.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
• Effective communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Ability to work remotely from a home office without on-site Supervision
• Proficiency in coding software and electronic health record (EHR) systems.
• High school diploma or equivalent GED required.
• Active certification is required. Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well. Other Medical Coding certifications may also qualify.
• At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).
• Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
• Some positions may require the total absence of felony and/or misdemeanor convictions.
• Must not appear on any state/federal debarment or exclusion lists.
• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

Nice-to-haves

• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.
• Coding for emergency care, observation, and same day surgery is preferred.
• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

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