The Auditing Specialist (Coding, CPC) is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy and clinical appropriateness of documented diagnosis. The Auditing Specialist (Coding) conducts quality reviews on coding staff documentation; conducts on-going and retrospective chart audits for the purposes of identifying charges and billing weaknesses, possible coding, documentation or compliance issues and reports discrepancies to the appropriate departments and makes recommendations to minimize their reoccurrence. The position helps the company evaluate operating guidelines, controls, procedures and reports identified problems to management. The position ensures that internal procedures correspond with corporate policies, grantor standards, contract deliverables and regulatory requirements (federal, state and country).

Essential Duties and Responsibilities

• Perform audits including operational, clinical, and compliance reviews across the organizational system. These audits will include but are not limited to: Conducting audits for appropriate clinical documentation, Billing Audits - Remittance Denial reviews, Medicare/Medicaid Audit - ACHA request, Provider Encounter audits for behavioral health, Patient Service audits - registration, encounter, cash, insurance verification, etc.
• Conducts audits based on an established schedule, which can be monthly, quarterly or a date determined by the funder or grantor.
• Prepares internal audit reports detailing the results of the reviews and Provides reports to appropriate on-site staff and leadership.
• Supports the mission of Huntingdon/MCR Health Services.
• Adheres to the safety policy of Huntingdon/MCR Health Services.
• Performs other duties and administrative tasks as assigned.

Requirements

• CPC required in Behavioral Health, CPMA preferred in Behavioral Health
• Must reside in State of Florida
• Prior chart auditing and coding experience.
• Well versed in outpatient and inpatient coding and reimbursement guidelines.
• Experience in the Microsoft Office with specific emphasis on Excel spreadsheets.
• Experience with internal auditing standards, techniques, and sampling procedures.
• Able to work independently and as part of a team