Medical Coding Auditor (Contract Role)
Elevate Patient Financial Solutions is seeking a highly skilled and experienced Medical Coding Auditor to join our team. This is a contract role working approximately 15-20 hours per week. The ideal candidate will have extensive expertise in both inpatient and outpatient hospital coding and a strong understanding of coding regulations, compliance, and reimbursement methodologies. This role requires at least 5 years of industry experience and involves auditing coded medical records to ensure accuracy, adherence to regulatory guidelines, and optimal reimbursement. The Medical Coding Auditor will also be responsible for providing education and feedback to HIM coding and Revenue Integrity staff and ensuring compliance with federal, state, and payer-specific regulations.
Key Responsibilities:
- Perform comprehensive coding audits for inpatient and outpatient hospital services, ensuring accuracy and compliance with ICD-10-CM, ICD-10-PCS, CPT, HCPCS, and DRG/APC assignment.
- Review medical records, provider documentation, and billing data to identify coding and/or charging errors, inconsistencies, and areas for improvement.
- Ensure adherence to CMS (Centers for Medicare & Medicaid Services), OIG (Office of Inspector General), and payer-specific guidelines.
- Provide constructive feedback and education to coding and billing staff to improve coding accuracy and compliance.
- Collaborate with clinical documentation improvement (CDI) specialists, physicians, and revenue cycle teams to ensure documentation supports coding and billing requirements.
- Stay up to date with industry regulations, coding updates, and payer policies, and ensure compliance with evolving standards.
- Other duties as assigned
Technical Skills and Knowledge:
- Proficiency in ICD-10-CM, ICD-10-PCS, CPT, HCPCS, DRG, and APC classification systems.
- Thorough understanding of Medicare, Medicaid, and commercial payer regulations.
- Familiarity with NCCI edits, LCD/NCD policies, and medical necessity guidelines.
- Experience with coding compliance audits.
- Strong analytical, research, and problem-solving skills.
- Data Analytics experience.
- Basic literacy
- Soft Skills:
- Excellent communication and training skills to provide education to coding teams and providers.
- Detail-oriented with strong organizational skills and the ability to manage multiple tasks efficiently.
- Ability to work independently and collaboratively with various healthcare teams.
- Preferred Certification from AHIMA/AAPC
- Preferred 2 years of Facility based coding.
- Preferred 2 years auditing or charge capture
Required Attributes:
- Ability to work under pressure
- Excellent attention to detail
- Goal-orientation
- Assertive
- Strong work ethic
- Systems thinking
- Multi-task orientation
- Integrity
- Team orientation
- Flexibility
- Initiative
- Profit orientation
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
ElevatePFS is an Equal Opportunity Employer
