Medical Coding Auditor
Location: Towson, Maryland US
Job Number: 3577
Position Title: Medical Coding Auditor
Pivot Health Solutions is now hiring a Medical Coding Auditor to join the Pivot team at our HQ in Towson, MD!
Summary/Objective: Reporting to the Director of Corporate Compliance, the Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations and guidelines. The Medical Coding Auditor also ensures that medical billing conforms to legal and procedural requirements.
- Audits medical record documentation to identify under-coded and up-coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues
- Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services
- Interacts with physical therapists and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation
- Trains, instructs, and/or provides technical support to medical providers as appropriate regarding coding compliance documentation, and regulatory provisions, and third party payer requirements
- Interacts with providers and management to review and/or implement codes and to update charge documents.
- Ensures strict confidentiality of financial and medical records
- Performs miscellaneous job-related duties as assigned
Knowledge, Skills and Abilities:
- ICD 10 CM/ICD-10-CM diagnostic and CPT/HCPCS procedure codes
- Ability to use independent judgment and to manage and impart confidential information
- Advanced knowledge of medical coding and billing systems and regulatory requirements
- Ability to analyze and solve problems
- Strong communication and interpersonal skills
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
- Knowledge of current and developing issues and trends in medical coding procedures requirements
- Ability to clearly communicate medical information to professional practitioners and/or the general public
- Detailed knowledge of medical coding systems, procedures, and documentation requirements
- Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
- Ability to provide guidance and training to professional and technical staff in area of expertise
Supervisory Responsibility: This is not a supervisory role.
Work Environment: office building
Position Type and Expected Hours of Work: Exempt (full-time)
Required Education and Experience:
- Certified Outpatient Coder (COC), Certified Professional Coder (CPC), or Certified Coding Specialist certification required
Address1: 501 Fairmount Avenue
Company: Pivot Physical Therapy
Community / Marketing Title: Medical Coding Auditor
Pivot Health Solutions is a premier provider of health and wellness services that focus on getting people back to health, preventing injury and staying fit where they work, live and play. Our core offerings include: Pivot Physical Therapy— helping people get back on the move by delivering the highest quality care and superior functional outcomes through evidence-based practice; Pivot Occupational Health— helping businesses keep workers healthy and safe, while controlling employee health care costs; Pivot Sports Medicine— helping athletes of all ages meet their performance needs with personalized services to safely prevent or recover from sports-related injuries; and Pivot Performance— helping athletes at all levels reach peak performance with customized, instructor-led programs for individuals, semi-private groups and athletic teams. No matter where a person is on the spectrum of health, we have a personalized solution delivered by the best professionals in their chosen fields.
EEO Employer Verbiage:
Pivot Health Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Pivot Health Solutions complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Pivot Health Solutions expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Pivot Health Solution's employees to perform their job duties may result in discipline up to and including discharge.
Location_formattedLocationLong: Towson, Maryland US