A Coding Auditor assumes accountability for auditing diagnosis data that are collected from physicians and hospital medical records and ensures ICD-10 coding and compliance with risk adjustment requirements. A well-drafted Coding Auditor Resume mentions the following core duties and responsibilities – collecting and analyzing data to formulate recommendations and solutions based on audit trends, providing regular feedback to operations leadership, participating in and representing the department in business leadership groups; assessing and identifying training opportunities, maintaining current knowledge of requirements and guidance, and reviewing medical records that are coded and reviewed.
Qualifications needed to succeed in this career include – experience as a coder of medical records in a coding or insurance office setting; knowledge of medical terminologies, the ability to use appropriate software, and certified risk adjustment coder credentials. A high school diploma is commonly considered a minimum requirement.
Objective : A seasoned Coding Auditor with over five years of experience in conducting comprehensive audits to ensure compliance with coding standards and regulations. Proficient in identifying discrepancies in documentation and providing targeted education to healthcare providers. Committed to upholding the highest quality of coding practices while enhancing operational efficiencies within healthcare settings.
Conducted audits for a multi-specialty group of over 50 providers, focusing on compliance with CMS documentation guidelines.
Performed targeted audits for providers demonstrating non-compliance, delivering tailored educational feedback.
Reviewed Accounts Receivable (ADR) and CERT requests to ensure proper coding practices.
Facilitated shadowing sessions in clinics to enhance documentation quality.
Executed charge master audits guided by OIG work plans, ensuring adherence to federal regulations.
Collaborated with compliance teams to uphold CMS, OIG, and federal standards across all coding practices.
Analyzed coding patterns to identify areas for improvement and implement corrective actions.
Experience
2-5 Years
Level
Junior
Education
BS-HIM
Coding Auditor Resume
Objective : Bringing over five years of specialized experience as a Coding Auditor, I excel in executing detailed audits to ensure adherence to coding regulations and standards. My expertise lies in analyzing medical documentation to pinpoint inaccuracies while providing comprehensive training to healthcare professionals.
Skills : Auditing Medical Records, Training Healthcare Providers, Data Analysis & Reporting, Regulatory Compliance, Risk Assessment
Description :
Executed coding compliance audits for patient care billing documentation, delivering findings to the Coding Compliance Lead and Coordinator.
Reviewed medical charts for completeness, ensuring accurate coding of diseases and procedures.
Audited records to verify proper service submissions prior to billing on selected charges.
Collaborated with hospital staff to ensure accurate billing for provider services.
Participated in ongoing education to remain updated on coding standards and regulations.
Provided targeted coding training and resources to healthcare providers and billing teams.
Communicated best practices and coding strategies to medical staff to enhance documentation and maximize reimbursement.
Experience
2-5 Years
Level
Junior
Education
BSHIM
Coding Auditor Resume
Headline : With seven years of extensive experience in coding audits, I specialize in ensuring compliance with healthcare coding regulations and standards. My analytical skills enable me to detect discrepancies in medical documentation, and I am dedicated to educating healthcare providers on best practices.
Skills : Proficient in Microsoft Word, Expert in Microsoft PowerPoint, Skilled in EncoderPro Software, Proficient in eClinicalWorks, Experienced in IC-Chart Systems
Description :
Assigned accurate CPT, HCPCS, and diagnosis codes to claims for multi-specialty providers, ensuring compliance with coding standards.
Managed charge postings to the billing system, enhancing revenue cycle efficiency.
Collaborated with Claims Specialists to verify accuracy of billed services during the prebill process.
Investigated and resolved claim denials, improving the overall claims approval rate.
Conducted monthly audits for Genesis Health System providers, ensuring adherence to coding best practices.
Provided guidance to office staff on coding, billing, and documentation issues to streamline operations.
Performed thorough medical record reviews for HEDIS HCC and RXHCC measures, enhancing data integrity.
Experience
5-7 Years
Level
Executive
Education
BS HIM
Coding Auditor Resume
Headline : With seven years of dedicated experience in coding audits, I possess a strong ability to analyze and assess compliance with healthcare coding regulations. My role involves meticulously reviewing medical documentation to identify discrepancies while providing impactful training to healthcare providers. I am passionate about enhancing coding accuracy and operational efficiency within healthcare systems.
Skills : Compliance Auditing, Regulatory Compliance Analysis, Medical Coding Standards, Documentation Review, Training and Development
Description :
Conducted thorough audits of physician charts to ensure compliance with established coding standards.
Performed coding for various specialties, including Peripheral Vascular, emergency room, and NICU.
Provided expert consultation across departments to promote correct coding practices.
Delivered training sessions on coding and documentation for Cath Lab, Radiology, MRI, CT Scan, and Pathology departments.
Ensured timely completion of all quotas and assignments to meet organizational goals.
Reviewed and corrected coding discrepancies as necessary.
Facilitated technical coding navigation assistance through AHLTA for clinical staff.
Experience
5-7 Years
Level
Executive
Education
B.S. H.I.M.
Coding Auditor Resume
Summary : With a decade of experience as a Coding Auditor, I excel in performing meticulous audits to ensure compliance with healthcare coding standards. My expertise lies in identifying documentation discrepancies and implementing effective training programs for healthcare providers. I am dedicated to enhancing coding accuracy and operational efficiency, driving improvements in healthcare practices.
Skills : Microsoft Office Suite, Database Management, Pdoc Systems Expertise, ICD-10 Coding Expertise, CPT Coding Proficiency
Description :
Executed thorough coding audits to verify adherence to regulatory standards and best practices.
Identified discrepancies in medical documentation, providing actionable feedback to healthcare providers.
Conducted training sessions to improve coding accuracy and compliance among staff.
Collaborated with interdisciplinary teams to enhance operational efficiencies in coding processes.
Reviewed and validated HCC coding claims for accuracy and completeness.
Ensured timely processing of medical claims, reducing accounts receivable days to 28.
Monitored and evaluated coder performance, implementing corrective actions as necessary.
Experience
7-10 Years
Level
Management
Education
BSHIM
Coding Auditor Resume
Summary : With a decade of expertise in coding audits, I have honed my skills in evaluating compliance with industry standards and regulations. My analytical acumen allows me to identify discrepancies in medical documentation, while my commitment to training healthcare professionals fosters a culture of continuous improvement. I am passionate about enhancing coding accuracy and operational excellence in healthcare environments.
Directed comprehensive reviews and audits of outpatient services to resolve claims and enhance coding accuracy.
Abstracted surgical codes across multiple specialties, providing expert support for physician coding inquiries.
Delivered tailored one-on-one coaching and educational sessions for clinical staff to elevate coding proficiency.
Processed and reviewed medical records for inpatient coding, ensuring strict adherence to federal and state regulations.
Conducted thorough research of Medicaid guidelines, adapting audit processes to comply with varying state regulations.
Leveraged Excel data analytics to track audit outcomes and identify trends in coding discrepancies.
Performed concurrent ICD-10-CM and CPT coding analysis of medical records, validating code assignments for accuracy.
Experience
7-10 Years
Level
Management
Education
BS HIM
Coding Auditor Resume
Summary : As a Coding Auditor with a decade of expertise, I specialize in conducting thorough audits that ensure compliance with healthcare coding regulations and standards. My analytical skills enable me to detect inaccuracies in medical documentation, while I also develop and deliver training programs to enhance coding practices.
Skills : ICD-10 Coding Expertise, Healthcare Compliance Auditing, Medical Documentation Analysis, Training and Development, Error Resolution Strategies
Description :
Performed comprehensive audits of multi-specialty encounters to ensure compliance with ICD-10 coding standards.
Reviewed physician documentation for adherence to coding regulations and identified areas for improvement.
Collaborated with healthcare providers to resolve documentation deficiencies through targeted queries.
Conducted detailed analyses of outpatient coding practices across various specialties.
Identified and corrected back-end coding errors, ensuring accurate billing processes.
Partnered with clinic coders and managers to standardize documentation practices and improve accuracy.
Assisted in denial management by reviewing documentation for successful appeals.
Experience
7-10 Years
Level
Management
Education
BSHIM
Coding Auditor Resume
Summary : Results-driven Coding Auditor skilled in identifying coding discrepancies and ensuring compliance with regulations. Successfully improved coding accuracy rates by 25% in previous role, enhancing revenue cycle efficiency.
Educated staff on coding regulations and best practices to enhance overall coding accuracy.
Utilized advanced coding software to streamline audit processes and improve efficiency.
Collaborated with interdisciplinary teams to address coding-related issues and implement solutions.
Maintained up-to-date knowledge of coding guidelines and regulatory changes.
Provided ongoing support and training to new staff on coding procedures and compliance.
Conducted comprehensive coding audits, improving accuracy by 25% and reducing claim denials by 15%.
Reviewed and analyzed coding practices, leading to a 30% increase in compliance with industry standards.
Experience
7-10 Years
Level
Management
Education
BSHIM
Coding Auditor Resume
Summary : Proficient Coding Auditor with a strong background in healthcare compliance and coding standards. Achieved a 20% reduction in coding errors through comprehensive audits and targeted educational initiatives for coding staff.
Skills : Coding Guidelines Expertise, Regulatory Compliance Knowledge, Data Analysis and Reporting, Medical Documentation Review, Training and Development Skills
Description :
Conducted comprehensive audits to ensure adherence to coding standards and regulations.
Identified discrepancies in medical documentation, leading to improved accuracy in coding.
Developed training materials and conducted workshops for healthcare providers.
Utilized coding guidelines to provide feedback and support to coding staff.
Monitored and reported on coding compliance metrics to drive improvements.
Ensured inter-reviewer consistency and reliability in coding practices.
Developed and implemented coding guidelines, resulting in a 20% decrease in coding errors across departments.
Experience
7-10 Years
Level
Management
Education
BS HIM
Coding Auditor Resume
Summary : Analytical Coding Auditor with a focus on optimizing coding practices and enhancing documentation. Instrumental in developing training programs that improved coder performance and reduced compliance risks by 15%.
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