Medical Coding Auditor-Outpatient

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range:61,300.00 - $71,000.00

The Medical Coding Auditor-Outpatient 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.
 

Key Responsibilities to include:

• 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.

Knowledge, Skills and Abilities Needed:

• 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.

Required and Preferred Qualifications:

• High school diploma or equivalent GED required.

• Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred.

• 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.

• 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.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, di