Professional Billing Quality Coding Auditor, FT, Days, - Remote

Prisma Health

  • Greenville, SC
  • 2 days ago

    Highlights

    Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings. Knowledge of medical terminology and basic anatomy and physiology with the ability to apply coding concepts to ensure correct coding.

    Numbers & Facts

    LocationGreenville, SC

    Description

    Inspire health. Serve with compassion. Be the difference.

    Job Summary

    Performs routine and specialty reviews of coders to ensure accurate coding. Prepares a summary of findings and presents reports to leadership on a monthly basis. Assists with training coders on identified opportunities for improvement. Assists in preventing coding denials.

    Essential Functions

    • All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.

    • Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings.

    • Performs review of all coders within the department and prepares a summary of findings.

    • Provides training to coders on identified issues found during reviews.

    • Codes charges for professional billing based on review of clinical documentation.

    • Identifies and assists with the resolution of coding issues and process improvement.

    • Assists in creating edits to prevent denials.

    • Assists in creating a standardized process for front end coding including the development of training materials.

    • Mentors and trains coders on correct coding guidelines.

    • Interacts with other departments to assist in resolving coding.

    • Performs other duties as assigned.

    Supervisory/Management Responsibilities

    • This is a non-management job that will report to a supervisor, manager, director or executive.

    Minimum Requirements

    • Education - Bachelor's degree in Business or related field of study

    • Experience - Three (3) years multi-specialty coding experience in professional billing

    In Lieu Of

    • NA

    Required Certifications, Registrations, Licenses

    • CPC Certified Professional Coder (AAPC) and

    • CPMA Certified Professional Medical Auditor (AAPC)

    Knowledge, Skills and Abilities

    • Knowledge of medical terminology and basic anatomy and physiology with the ability to apply coding concepts to ensure correct coding.

    • Analytical skills.

    • Working knowledge of Epic, Encoder Pro, 3M

    • Ability to work independently and manage multiple projects consistently

    • Proficient computer skills (word processing, spreadsheets, database)

    • Data entry skills

    Work Shift

    Day (United States of America)

    Location

    Independence Pointe

    Facility

    7001 Corporate

    Department

    70019178 Medical Group Coding & Education Services

    Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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