Coding Compliance Auditor
Catalytic Solutions is a technology centric end to end RCM services provider to the US Healthcare space. Our full spectrum RCM services includes billing, coding, scheduling services to hospitals, Physician Groups, DME Suppliers. We also provide back-office services to Payors, TPAs or Clearing Houses. We strive towards our clients’ growth and transformation and we believe in challenging the status quo.
Performs audits to promote organizational integrity of billing and coding for professional services. Evaluates the accuracy of ICD/CPT/HCPCS and other third-party payor codes. Verifies adequacy of documentation in support of services billed, including teaching physician guidelines, medical necessity, and compliance with other documentation, coding, and billing standards.
- Following a pre-determined or assigned audit schedule, provide an evidence-based audit of select primary and specialty care E&M and procedural charges to ensure correct coding, legal compliance and complete charge capture.
- Using CPT- 4, ICD-10 and HCPCS II, provider documentation and other approved resources, evaluate the proper assignment of procedure, modifier and diagnosis codes to professional services in order to validate accuracy and compliance.
- Collate, transfer and analyze all auditing results to capture and illustrate risk issues, revenue leakage and educational opportunities.
- Provide inputs for physician feedback, initial and ongoing education and training, and technical support in regards to proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles.
- Assist with developing and implementing recommendations for changes in policies and procedures relevant to correct and compliant coding.
- Perform Coding and auditing for Outpatient and/or Inpatient records with a minimum of 96% accuracy and as per turnaround time requirements
- Focuses on continuous improvement by working on projects that enables customers to arrest revenue leakage while being in compliance with the standards
- Serve as a resource for physicians, billing and coding staff and administrative staff relative to technical guidance on professional coding issues.
- Stay current with all coding changes and updates through regular research and verification.
- Maintains high degree of professional and ethical standards
- A minimum of 3 - 5 years of experience in Medical Coding Audit and Physician Education, preferably in E&M Coding (Internal Medicine, Family Medicine and Paediatrics) will be a plus
- Exposure to CPT-4, ICD-9, ICD-10, and HCPCS coding
- CCS/CPC/CPC-H/CIC/COC certification from AAPC /AHIMA would be a plus
- Current Coding certification with valid proof of certifications
- Good knowledge of medical coding and billing systems, regulatory requirements, auditing concepts, and EM coding principles
- Good Knowledge in medical necessity audits including LCDs/NCDs, coding accuracy standards and HEDIS measures is a must
Job Type: Contract
- coding Pediatrics: 3 years (Required)
- Outpatient coding and auditing: 3 years (Required)
- Physician Education in E/M Coding: 3 years (Required)
- coding for Family Practice: 3 years (Preferred)
- coding for Internal Medicine: 3 years (Preferred)
- knowledgable of HEDIS measures is: 3 years (Required)
- Medical Coding Audit in E/M coding: 3 years (Required)
- CPT-4, ICD-9, ICD-10, and HCPCS coding: 3 years (Required)
- * CCS/CPC/CPC-H/CIC/COC (Required)