Professional Billing Quality Coding Auditor, FT, Days, - Remote

Role Summary

Inspire health. Serve with compassion. Be the difference.

Performs routine and specialty reviews of coders to ensure accurate coding. Prepares a summary of findings and presents reports to leadership on a monthly basis. Assists with training coders on identified opportunities for improvement. Assists in preventing coding denials.

Responsibilities

• All team members are expected to be knowledgeable and compliant with Prisma Health 's purpose: Inspire health. Serve with compassion. Be the difference.
• Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings.
• Performs review of all coders within the department and prepares a summary of findings.
• Provides training to coders on identified issues found during reviews.
• Codes charges for professional billing based on review of clinical documentation.
• Identifies and assists with the resolution of coding issues and process improvement.
• Assists in creating edits to prevent denials.
• Assists in creating a standardized process for front end coding including the development of training materials.
• Mentors and trains coders on correct coding guidelines.
• Interacts with other departments to assist in resolving coding.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

• Minimum Requirements
• Education - Bachelor's degree in Business or related field of study
• Experience - Three (3) years multi-specialty coding experience in professional billing
• In Lieu Of
• NA
• Required Certifications, Registrations, Licenses
• CPC Certified Professional Coder (AAPC) and
• CPMA Certified Professional Medical Auditor (AAPC)

Requirements

Knowledge, Skills and Abilities

• Knowledge of medical terminology and basic anatomy and physiology with the ability to apply coding concepts to ensure correct coding.
• Analytical skills.
• Working knowledge of Epic, Encoder Pro, 3M
• Ability to work independently and manage multiple projects consistently
• Proficient computer skills (word processing, spreadsheets, database)
• Data entry skills
• Work Shift
• Day (United States of America)
• Independence Pointe
• Facility
• 7001 Corporate
• Department
• 70019178 Medical Group Coding & Education Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health .