Medical Coding Auditor

Job Description

Job Description

We are looking for a detail-oriented Medical Coding Auditor to join our team in Cincinnati, Ohio. In this Contract-to-Permanent position, you will play a critical role in ensuring the accuracy and compliance of outpatient medical coding processes. This role is ideal for professionals with a strong background in medical coding and auditing who are eager to contribute to high-quality healthcare documentation.

Responsibilities :

• Review medical records and assign accurate ICD-9-CM, ICD-10, and CPT codes using 3M software tools across various outpatient work types, including ancillary services, emergency department visits, same-day surgeries, and observation cases.
• Ensure assigned codes align with documented medical necessity and the reason for the visit as stated by the healthcare provider.
• Apply appropriate charges for services such as Evaluation & Management (E& M) levels, injections, infusions, and other requirements for observation cases using third-party software systems.
• Abstract required data in accordance with facility-specific guidelines.
• Conduct medical necessity checks for Medicare and other payers based on established payment regulations.
• Maintain compliance with coding standards and regulatory requirements to support accurate billing and reimbursement.
• Collaborate with healthcare providers and other team members to resolve coding discrepancies and ensure proper documentation.
• Participate in audits and quality assurance activities to identify areas for improvement in coding accuracy.
• Stay updated on industry changes, coding guidelines, and software tools to enhance efficiency and effectiveness in coding practices.
• At least 1 year of experience in medical coding, preferably in outpatient settings.
• Proficiency in ICD-10, CPT codes, and certified coding practices.
• Strong knowledge of outpatient coding across various specialties, including OBGYN, interventional cardiology, vascular, urology, neurology, general surgery, anesthesiology, wound care, and neurological surgery.
• Certification in medical coding (e.g., CPC, CCS, or equivalent) is required.
• Familiarity with Epic software and other coding tools.
• Ability to perform detailed reviews of medical records to ensure compliance with coding and billing standards.
• Excellent analytical and problem-solving skills to identify and address coding discrepancies.
• Strong communication skills to collaborate effectively with healthcare providers and team members.