Surgical Coding Auditor
We are seeking a highly skilled Surgical Coding Auditor to join our team.
The Auditor will provide formal and informal coding and regulatory education to all CU Medicine coding/charge capture staff, billing staff, all attending physicians, residents and APP providers involved with the billing for professional services as directed by Federal and State requirements as well as the AMA. The individual in this position will also conduct internal audits to ensure anyone involved in the billing for professional services is in accordance with Federal and State regulations and payor policies and procedures. This position will work in support of our surgical specialties.
Responsibilities of the Auditor include but are not limited to:
- Perform detailed coder audits on a regular basis as defined by compliance requirements, determine if additional education is necessary and notify Training and Development of ongoing education needs.
- Work closely with the Education Program Manager to create, revise and update all online/web/PowerPoint education modules and materials as it relates to the coding and regulatory guidelines under the direction of Audit, Compliance & Education leadership.
- 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 and/or standards.
- Evaluate the appropriateness of the services and procedures billed based on the supporting documentation.
- Evaluate the appropriateness of diagnoses billed for all services in accordance with coding guidelines.
- Evaluate propriety of the level of service billed for evaluation and management services based on the supporting documentation.
- Evaluate the appropriateness of the EHR functionality being used, completing second level reviews on high complexity services.
educational documentation and coding training for clinicians, and
residents to support compliance with third party documentation and
- Prepare formalized reports from audit software of audit results and present the results to ACE leadership, clinical chairs, and physicians.
- Respond independently to questions from physicians and School of Medicine (SOM) department administrative staff regarding billing, coding and documentation.
- Develop educational programs for providers based on audit findings along with general education on coding and documentation rules and regulations.
- Perform follow-up reviews after initial training of physicians and determine if additional education is necessary.
- Provide any additional training once identified by follow-up review.
- Communicate regularly with internal departments to ensure all necessary information is received on a timely basis.
- Communicate and problem solve with Managers and Supervisors on specific coding issues and/or training requests.
- Work on joint projects with other internal audit staff and internal CU Medicine departments to resolve billing and documentation issues.
- Perform any and all other assigned responsibilities.
Requires a bachelor’s degree in healthcare administration (or related field) or equivalent/relevant work experience. The ideal candidate will have 3yrs of auditing experience. Must possess an active CCS-P or CPC or RHIA/RHIT certification in conjunction with auditing credentials (i.e. CPMA). Demonstrated knowledge of Medical Terminology and Anatomy & Physiology combined with high level expertise in third-party payer reimbursement, coding, and documentation requirements are essential to success. Knowledge of Medicare and Medicaid regulations is required. Must have advanced experience in Evaluation and Management coding. Experience in a teaching/academic medical environment is a plus. The ideal candidate will demonstrate superior communication skills including verbal, written and large audience presentations. The ability to train/teach adults is essential to success. High level proficiency in the use of various computer systems including Microsoft Word, Excel, PowerPoint, and other database software skills are required.
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. 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.
- Pay Type Salary
- University of Colorado Medicine, AURORA, Colorado, United States of America