Medical Auditor

Are you an experienced Medical Coder seeking a career growth? Are you a Certified Auditor interested in a new work opportunity? If so, then we want to connect with you!

MAHEC is now accepting candidates for Medical Auditor. This integral role supports MAHEC's mission of educating the next generation of healthcare professionals by completing internal quality assessment reviews on Care Provider coding and effectively builds relationships with MAHEC Care Providers to educate and foster complete, accurate, timely, and consistent coding. The Auditor/Provider Educator is responsible for documentation to ensure compliance with national coding guidelines and MAHEC policies.

• We welcome experienced Medical Coders interested in becoming a Certified Professional Medical Auditor, and MAHEC offers an employer-sponsored pathway to CPMA certification if hired for the position!

• This is a hybrid work opportunity, with roughly 50-60% onsite work to support in-person collaboration and Medical Provider audit trainings, blended with dedicated work-from-home time for focused independent work during your work week.

• This full-time position is eligible for MAHEC's full Total Rewards Package, including healthcare coverage, pet insurance, up to 30 days PTO annually and more!

SPECIFIC RESPONSIBILITIES:

Auditing - Medical Coding

• Conducts quality assessment reviews as pre-billing audits and include outpatient, inpatient, and surgical records.
• Collaborates with the Clinical Business Office (CBO) Director and Business Office Manager to review and educate the coding team to improve accuracy, integrity and quality of patient data to ensure minimal variation in coding practices.
• Develops internal audit plan in collaboration with the Compliance Officer.
• Complete service based audits as needed.
• Performs pre-billing and procedure audits of evaluation and management services for patient encounters by utilizing national coding and payer specific guidelines to ensure accuracy of diagnosis codes and provider documentation; track accuracy and trend data to identify areas for improvement.
• Provides technical guidance and education to providers in identifying and resolving issues or errors.
• Reviews claim denials pertaining to coding and medical necessity issues and collaborates with key stakeholders to implement corrective actions to include education or workflow changes.
• Develops quality audit reports that analyze the data, identify trends/opportunities and proposes strategies for resolution and educational opportunities.
• Stays current of coding, compliance and billing requirements by various government/regulatory agencies and payors to effectively apply this knowledge to complex coding, quality and compliance situations.
• In collaboration with the Compliance Officer, helps facilitate external pre-billing audits conducted throughout the year, including but not limited to, identifying and suspending encounters, reviewing external auditor responses, follow-up with external auditor and provider education.
• Engages in proactive thinking by recommending actions for improving coding compliance or workflow improvement opportunities.

Provider/Learner Education - Medical Coding

• Provides provider education based on the quality monitoring review findings and trends.
• Orients new Residents and other Learners as needed to appropriate medical coding practices.
• Assists physicians and other providers with coding presentations as needed.
• Meets with Residents/Learners on a regular schedule and individually on an as needed basis to review completeness and appropriateness of patient encounter documentation in compliance with coding guidelines.
• Education for new providers during their orientation process to ensure understanding of MAHEC billing and coding practices
• Responds in a timely manner to inquiries from other departments regarding patient charges, appropriate diagnosis coding and other coding questions related to the revenue cycle.
• Serves as a resource for department managers, staff, providers and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements and new coding initiatives.