Coding Quality Auditor

Riverchase Dermatology, an AQUA Dermatology portfolio practice, is Florida's largest and most comprehensive full-service skin care provider in the Southeast, offering medical, surgical, and cosmetic dermatology, plastic surgery, vein care, and radiation oncology. Founded in 1998, AQUA Dermatology is the Southeast's premier dermatology practice with over 86 locations throughout Florida and Georgia. Our established practices and experienced physicians offer patients the most quality outcomes and an exceptional patient experience. From common rashes to skin cancer treatments, plastic surgery procedures to an array of vein treatments, no case is beyond our experience and expertise

The Coding Quality Auditor will ensure coding and billing compliance through ongoing audits and education of providers and staff. Using a combination of regulatory, coding, documentation, and billing knowledge the Coding Quality Auditor will complete reviews of assigned providers to assess the adequacy of the medical record documentation to support the services billed in accordance with professional fee coding and billing guidelines investigating and researching claims for aberrant billing patterns through review of the medical record documentation.

The Coding Quality Auditor will work with the (Health Information Manage) HIM to monitor and aid in improving the quality of documentation related to the requirements to bill for services provided as needed. It is the primary function of the Coding Quality Auditor to provide first-line coding support to providers, ongoing training and education to providers, clinical staff, and other affected personnel for improved documentation, best coding practices to ensure compliance with Riverchase Dermatology standards, Medicare, OIG, AMA, and health insurance payer policies

ESSENTIAL FUNCTIONS

• Conducts pre-pay and post-pay audits to ensure accurate claim payments and denials.

• Performs audit of documentation as requested by external entities and assists in record collection submission and appeals.

• Audits medical record documentation to ensure all services provided are accurately and appropriately reported using correct CPT and ICD-10 codes identify coding deficiencies of services billed i.e., under/over coding.

• Serves as coding expert resource for the providers. Researches and resolves complex coding/documentation issues.

• Communicates with providers regarding medical record documentation to maximize accuracy, completeness, and compliance with standards of practice and current coding guidelines.

• Communicates unusual/complex issues, identifies trends, and potential problems in medical documentation, and audit findings to HIM for guidance.

• Supports HIM in effectively and efficiently addressing and resolving all coding and documentation issues.

• Provides support to all RCM departments to establish and achieve revenue cycle goals/objectives. Appraise, support, and assist with training as necessary.

• Participates in educational activities to maintain current credentials, as well as enhance knowledge and skills.

• Attends department staff meetings. Available to provide assistance to other departments as requested by management.

• Maintains the strictest confidentiality, adhering to all HIPAA guidelines.

We offer competitive salaries and benefits:

• Medical, Dental, and Vision available after 30 days of hire

• Short-term disability and life insurance, and many ancillary options.

• 401k available after 90 days of hire

• Excellent growth and advancement opportunities

POSITION TYPE AND EXPECTED HOURS OF WORK

• Full-Time

• Monday

• Friday

• 8 am

• 5 pm

TRAVEL

Travel is not required for this position

QUALIFICATIONS

Education

• The candidate will need to either hold a current certification (CPC from AAPC or CCS from AHIMA) OR be currently in school/program with intentions of obtaining certification within 6 months of hire. (Certification preferred)

Experience

• Current knowledge of coding guidelines and current CPT, ICD-10, and HCPCS coding, fee schedule reimbursement methodology, and regulatory requirements for provider coding and reimbursement. Working knowledge of key coding concepts, such as CPT modifiers, surgical packages, medical record documentation requirements, and multiple procedure guidelines. Proficient in analyzing statical data.

Communication

• Excellent oral and written communication skills.

Work Style

• Must be able to work well independently and efficiently but ask for help when needed. Ability to analyze and interpret information, ability to interact and decipher information telephonically and electronically. Good organizational, analytical, and time management skills.