What are the responsibilities and job description for the Medical Coder Auditor position at Premier Medical Resources and Careers?
Revenue Cycle Management is looking for a Medical Coder Auditor to join our team!
SUMMARY
The Medical Coder Auditor is responsible for reviewing coded encounters to ensure accuracy, compliance, and alignment with coding guidelines, payer rules, and organizational policies. This role provides feedback to coders, identifies trends in errors, and supports coding education and process improvement initiatives.
The Medical Coder Auditor is responsible for reviewing coded encounters to ensure accuracy, compliance, and alignment with coding guidelines, payer rules, and organizational policies. This role provides feedback to coders, identifies trends in errors, and supports coding education and process improvement initiatives.
ESSENTIAL FUNCTIONS:
- Conduct retrospective and prospective coding audits to ensure coding accuracy and compliance with regulations.
- Review coded documentation for completeness, accuracy, and adherence to ICD-10-CM, CPT, HCPCS, and/or ICD-10-PCS guidelines.
- Identify coding trends, error patterns, and compliance risks, and develop corrective action plans.
- Provide feedback and education to coders to improve accuracy and consistency.
- Collaborate with providers and clinical staff to clarify documentation as needed.
- Prepare audit reports, track coding quality metrics, and communicate results to leadership.
- Assist in resolving complex coding questions, claim edits, and denials.
- Support the development of coding policies and procedures to align with best practices.
- Maintain up-to-date knowledge of coding regulations and payer requirements.
- Develop audit tools and standard operating procedures to ensure consistency in audits.
- Track trends and generate reports on coding accuracy, compliance, and productivity.
- Collaborate with leadership to implement corrective actions and staff training
KNOWLEDGE, SKILLS, AND ABILITIES:
- Strong knowledge of ICD-10-CM, CPT, HCPCS, and ICD-10-PCS coding guidelines.
- Ability to analyze complex coding issues and communicate findings clearly.
- Excellent auditing, critical thinking, and documentation skills.
- Strong interpersonal skills with the ability to coach and mentor coders.
- Proficiency with coding software, EHRs, and auditing tools.
- Critical thinking and decision-making in evaluating coding accuracy.
- Strong organizational skills for managing multiple audits and reporting deadlines.
- Knowledge of regulatory and payer compliance requirements.
EDUCATION AND EXPERIENCE:
- High school diploma or GED
- Five (5) years of experience in coding, with at least two (2) years in auditing or quality review.
- Certified Professional Coder (CPC) / Certified Outpatient Coder (COC) by AAPC or; Certified Coding Specialist (CCS) by AHIMA.
BENEFITS:
- 3 Medical Plans
- 2 Dental Plans
- 2 Vision Plans
- Employee Assistant Program
- Short- and Long-Term Disability Insurance
- Accidental Death & Dismemberment Plan
- 401(k) with a 2-year vesting
- PTO Holidays
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.
Employment for this position is contingent upon the successful completion of a background check and drug screening.