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Medical Coding & Documentation Auditor

Company CU Medicine
Location Aurora, CO
Update 8 Day ago
CU Medicine (formerly University Physicians, Inc.) is dedicated to providing healthcare and administrative support to the University Of Colorado School Of Medicine’s nearly 3,000 providers.

We are seeking a highly motivated Medical Coding & Documentation Auditor to join our team.

The Auditor is responsible for conducting internal audits of the medical documentation, coding, and billing in the provider setting and will ensure compliance with Federal and State regulations and payer policies and procedures. The audits performed by this individual will determine whether services provided to patients are billed accurately and are consistent with medical record documentation and in accordance with the appropriate third party billing regulations and/or standards. The Auditor will communicate findings to Medical Staff and other appropriate personnel and will provide education on identified issues.

Provide formal and informal coding and regulatory education to all coding/charge capture staff, billing staff, attending physicians, residents, and non-MD providers involved with billing for professional services as directed by Federal and State requirements and AMA coding directives.

Create educational materials such as hand-outs, PowerPoint presentations and other tools to be used during educational sessions.

Perform coder audits on a regular basis as defined by compliance requirements, determine when additional education is necessary and provide training once identified.

Present monthly coding roundtables for continuing education of the coding personnel.

Conduct internal audits of medical documentation supporting claims billed to third parties to ensure billing is done in accordance with the appropriate third party regulations.

Evaluate the appropriateness of the services and procedures, diagnoses and E&M service levels billed based on the supporting documentation and in accordance with coding guidelines.

Prepare written reports of audit results and present this information to management, clinical chairs, physicians, and department billing staff.

Respond to questions from physicians and CU School of Medicine (SOM) department administrative staff regarding billing, coding and documentation.

Assist in the development of educational programs for providers based on audit findings, as well as general education on coding and documentation rules and regulations.

Participate in the revision of materials used by coding and billing staff.

Communicate regularly with internal departments to ensure all necessary information is received on a timely basis at the direction of management.

Attend committee meetings as assigned by Manager/Director.

Provide support to joint projects with other internal audit staff and internal CU Medicine departments to resolve billing and documentation issues.

Perform other duties as assigned by management.

Requires a bachelor’s degree in healthcare or related field; equivalent work experience may be accepted in lieu of a degree. ICD10-CM and CPC, CCS-P, or RHIT certification is required; CPMA highly preferred. Must have experience in CPT-4 and ICD-9 coding and have in-depth knowledge of third-party payer reimbursement, coding, and documentation requirements. Solid knowledge of Medicare and Medicaid regulations and experience in Evaluation and Management coding is required. Epic EHR system and Optum Computer Assisted Coding knowledge is highly preferable. Experience training/teaching adult audiences is a plus. High proficiency in the use of various computer systems including Microsoft Word, Excel, PowerPoint, and other database software skills required. Must have superior verbal and written communication skills and possess the ability to successfully present information to large audiences. The ability to manage multiple tasks and prioritize work is essential.

All applications MUST be submitted via our website.

CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. Additionally, drug and health screenings may be required for some positions. We are an equal opportunity employer.

CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.