Medical Coding Auditor II

• Objectively and accurately conduct coding reviews on medical records for assigned client audit contract while meeting compliance, productivity and quality expectations.
• Appropriately refer reviews for clinical validation.
• Enter and update all contract and/or review findings a supporting documentation into the audit processing system.
• Write logic/parameters for system edits to detect incorrect coding over payments, aberrant and abusive coding patterns.
• Proof of concept development and data analysis of reports for potential edit development.
• Monitor CMS and major payer coding and reimbursement policies.
• Assist in identifying new issues for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation.
• Maintain a current knowledge of all Medicare and Commercial regulations, policies and procedures.
• Maintain certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certification(s), as well as HIPPA and other compliance training provided by Performant.
• Develop and maintain professional working relationships within the department and cross-functionally.
• Other duties and responsibilities as assigned.

Knowledge, Skills and Abilities Needed

• You must possess a unique blend of medical coding experience, business aptitude, an understanding of payables/receivables, a critical eye for quality and accuracy, team spirit, and the self-drive to meet and exceed productivity goals.
• You must enjoy spending time solving complex issues, researching, and giving attention to detail.
• Candidates who will thrive in our collaborative environment enjoy variety in their work and are willing to learn new systems and client requirements, anytime and anywhere.
• Typing skills, comfortable navigating and using desktop technology, as well as working knowledge of MS Office applications (Outlook, Word, Excel).
• Possess knowledge of CMS rules and regulations.
• Proficient in the use of MCS 1500/UB 04 forms.
• Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10, MS-DRG coding.
• Working knowledge of encoder.
• Reimbursement policy and/or claims software analyst experience.
• Familiarity with interpreting electronic medical records (EHR).
• Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing.
• Adaptability of skills to handle any non-standard situations that may arise or apply skills in new ways as may be required to meet business needs.
• Ability to multi-task effectively and work independently in a remote setting.
• Excellent written and verbal communication skills.

Required and Preferred Qualifications

• Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P. Other relevant certifications may be considered.
• At least 3 years of (MS/APR) DRG coding for hospital or other acute facility setting (inpatient/SNF Facility) is required.
• At least 2 years of direct experience in medical chart review for all provider/claim types for inpatient/outpatient.
• At least 2 years of experience coding/auditing facility outpatient services.
• Prior auditing experience in either a provider or payer environment is preferred.
• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.