Medical Coding Auditor-Outpatient (OIG Focus) Clearance required

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

About the position

The Medical Coding Auditor-Outpatient - (OIG Focus) is responsible for ensuring the accuracy, integrity, and compliance of medical coding practices within the organization, with a primary focus on Outpatient services. This role involves auditing medical records, coding data, and billing information to verify adherence to coding guidelines and regulations. The Medical Coding Auditor plays a crucial role in minimizing coding errors, preventing fraudulent activities, and ensuring that the organization meets all applicable standards and requirements.

Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes.
Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards.
Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation.
Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards. Conduct workshops and seminars as needed.
Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement. Present reports to management and relevant stakeholders.
Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency.
Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes.
Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications.

Extensive knowledge of ICD-10, CPT, and HCPCS coding systems.
Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements.
Understanding of medical terminology, anatomy, and physiology.
Strong analytical and problem-solving skills.
Excellent attention to detail and accuracy.
Effective communication and interpersonal skills.
Ability to work independently and as part of a team.
Ability to work remotely from a home office without on-site Supervision
Proficiency in coding software and electronic health record (EHR) systems.
High school diploma or equivalent GED required.
Active certification is required. Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well. Other Medical Coding certifications may also qualify.
At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types.
Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).
Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
Some positions may require the total absence of felony and/or misdemeanor convictions.
Must not appear on any state/federal debarment or exclusion lists.
Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.
Coding for emergency care, observation, and same day surgery is preferred.
Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.
Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.

Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

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