Physician Auditor / Coder

Medkoder is looking for an experienced multi-specialty, certified professional coder with extensive knowledge of coding and auditing, for various E/M and surgical auditing projects with our clients. This is a FT REMOTE permanent position that offers the opportunity to work a flexible schedule.

Responsibilities:

• Performing audits of E/M coding and documentation compliance audits for providers, including physicians and mid-level providers;

• Accurate application of appropriate coding and documentation guidelines, including Evaluation and Management Documentation Guidelines, CPT Coding Guidelines, Coding Clinics, Specialty Association guidance and others, as applicable;

• Accurate selection of CPT codes to determine if the code was assigned without appropriate documentation to support the code (up-coded services);

• Accurate selection of CPT codes to determine if the code was assigned with documentation to support a higher level service (down-coded services);

• Accurate selection of CPT codes for procedures performed; Accurate application of modifiers to CPT codes; Accurate selection and evaluation of ICD-10 CM diagnosis coding;

• Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;

• Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor specific policies, if applicable;

• Appropriateness of documentation for split/shared or incident to services;

• Appropriateness of provider’s documentation related to Teaching Physician Guidelines, PQRS, FQHC and RHC's as applicable;

• Use scoring methodology to accurately score audits;

• Provide detailed findings for each service reviewed on an excel spreadsheet or other customized report, including supporting documentation;

• Communicate with Coding Team Lead on audit timeline task completion.

Qualifications:

Education/Cert: A minimum of a high-school diploma, Associates Degree preferred. Successful completion of at least one AHIMA or AAPC certified program with achievement of the correlating professional credential (CCS, CPC, etc.); active and in good standing, preferably a combination of two or more credentials. A CPMA certification is required.

Experience: Minimum 3 years physician coding experience and 3 years E&M and surgical auditing experience required. Must have proficient knowledge of medical terminology, CPT and/or ICD-9/10 coding and Medicare and Medicaid billing policies for professional services.

Additional skills required: Experience with Microsoft Word, Excel, PowerPoint, Windows and healthcare information and billing systems. Experience working independently, excellent time management skills and the ability to meet project deadlines a must.