Position Summary / Scope of Responsibility:

MedVanta is the nation's largest physician-owned and operated next generation management services organization (MSO). Our services are specifically designed for musculoskeletal (MSK) providers and go beyond that of a traditional MSO, empowering our clients with the precise infrastructure, data, technology, and administrative processes needed to thrive both today and tomorrow.

MedVanta has an employee centered culture that supports and promotes diversity and inclusion. Our encouraging and empowering management style makes MedVanta a great place to further grow your knowledge while building a team driven path to success.

The Medical Coding Auditor performs all internal, concurrent, prospective, and retrospective coding audit activities. The Auditor reviews medical records to determine data quality and accuracy of coding, billing, and documentation related to DRGs, APCs, CPTs, HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding according to regulatory requirements. Uses findings to generate topics for education, training, process changes, risk reduction, and optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with compliance programs to improve documentation which supports compliant coding.

Primary Responsibilities:

The incumbent may be asked to perform job-related tasks other than those specifically stated in this description. The duties and responsibilities of the position are to be carried out in a manner that is consistent with the Mission, Core Values and Operating Principles of MedVanta.

• Audits medical records to ensure compliance with the organization’s coding procedures and standards.
• Reviews insurance payments and denials and recommends billing corrections.
• Reviews and researches medical records to determine the accuracy of coding, billing, and supporting clinical documentation.
• Reviews medical records that have been reviewed and coded by the coding vendor.
• Reviews and researches billed unlisted procedure codes to determine if a more specific code exists and should be used.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies as necessary or required.
• Effectively communicates with providers to clarify diagnoses, procedure coding and documentation requirements, including proper sequencing.
• Reviews assigned ICD-10-CM codes, which most accurately describe each documented diagnosis and/ or procedure according to established ICD-10-CM and CPT-4 coding guidelines along with modifier usage and medical terminology.
• Monitors all coding accuracy at various levels of detail and maintains coding quality as needed.
• Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement. Reports or resolves escalated issues as necessary.
• Performs a comprehensive medical records review to assure the presence of all component parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Monitors, audits, and reconciles all documents required for data entry, returns incomplete or questionable documents to generating location or provider.

Reporting Relationships:

The Medical Coding Auditor reports directly to the Vice President of Revenue Cycle Management.

This role does not have direct reports.

Required Education and Experience:

1. CPC, CBCS, or CCS required. CCS-P preferred.
2. 3-5 years coding and auditing experience.
3. 1-2 years’ experience in practice management and education preferred.
4. Bachelor’s degree in health information management or related field of study preferred.
5. Proficiency with Microsoft Office suite of products as well as practice management and electronic health record systems.
6. Extensive knowledge of insurance, benefits, medical terminology, and medical billing.

Competencies / Required Skills and Abilities:

1. Strong interpersonal skills - ability to develop relationships and collaborate and influence in a centralized organization.
2. Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment with a proven track record of results.
3. Strong interpersonal, oral, and written communication skills with excellent self-discipline and patience.
4. Able to work independently.
5. Exudes professionalism in presentation.
6. Must be able to read, write, speak, understand, and communicate in the English language.

Physical Demands:

1. Must be able to sit for long periods of time and lift up to 25 pounds.
2. Must be able to use appropriate body mechanics techniques when performing front desk duties.
3. Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting.
4. Adequate hearing to perform duties in person and over telephone.
5. Must be able to communicate clearly to patients in person and over the telephone.
6. Visual acuity adequate to perform job duties, including reading materials from printed sources and computer screens