Medical Coding Auditor Resume
Summary : As a Medical Coding Auditor, performed detailed coder audits regularly as defined by compliance requirements, determined if additional education was necessary, and notified Training and Development of ongoing education needs.
Skills : Medical Coding Knowledge, Healthcare Terminology.
Description :
- Worked closely with the Education Program Manager to create, revise, and update all online/web/PowerPoint education modules and materials as they relate to the coding and regulatory guidelines under the direction of Audit, Compliance, and education leadership.
- Conducted internal audits of medical documentation supporting claims.
- Billed to third parties to ensure billing was done per the appropriate third-party regulations and/or standards.
- Evaluated the appropriateness of the services and procedures billed based on the supporting documentation.
- Evaluated the appropriateness of diagnoses billed for all services per coding guidelines.
- Evaluated propriety of the level of service billed for evaluation and management services based on the supporting documentation.
- Evaluated the appropriateness of the EHR functionality being used, completing second-level reviews on high-complexity services.
Experience
10+ Years
Level
Senior
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Summary : As a Medical Coding Auditor, prepared formalized reports from audit software of audit results and presented the results to ACE leadership, clinical chairs, and physicians, responded independently to questions from physicians and School of Medicine (SOM) department administrative staff regarding billing, coding, and documentation.
Skills : Coding Guidelines, Analytical Skills.
Description :
- Developed educational programs for providers based on audit findings along with general education on coding and documentation rules and regulations.
- Performed follow-up reviews after the initial training of physicians and determined if additional education was necessary.
- Provided any additional training once identified by follow-up review.
- Communicated regularly with internal departments to ensure all necessary information is received on a timely basis.
- Communicated and problem-solved with Managers and Supervisors on specific coding issues and/or training requests.
- Worked on joint projects with other internal audit staff and internal CU Medicine departments to resolve billing and documentation issues.
- Conducted educational documentation and coding training for clinicians, and residents to support compliance with third-party documentation and billing standards.
Experience
7-10 Years
Level
Management
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Headline : As a Medical Coding Auditor, conducted a review of flagged claims and Fraud Waste and abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, and intentional miscoding.
Skills : Attention to Detail, Audit Procedures.
Description :
- Provided communication and guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements.
- Entered and updated all contract and/or review findings and supporting documentation into the audit processing system.
- Wrote logic/parameters for system edits to detect incorrect coding over-payments and aberrant and abusive coding patterns.
- Monitored CMS and major payer coding and reimbursement policies.
- Assisted in identifying new issues/investigative strategies for audit, and performed research to validate new issues.
- Provided new rules, regulations, and applicable Medicare or program language and explanation.
- Timely reviewed and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding.
Experience
5-7 Years
Level
Executive
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Objective : As a Medical Coding Auditor, maintained certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certifications, as well as HIPPA and other compliance training provided by Performant and clients.
Skills : Communication Skills, Regulatory Compliance.
Description :
- Notified management of all correspondence indicating displeasure with the Remittance Advice (RA), in the over-payment identification, or the recovery methods utilized, legal action, or government intervention.
- Assisted in developing material for training and facilitated or assisted in audit training sessions.
- Assisted in educating Performant team members on coding, policies, regulations, and appeal strategies, as needed.
- Performed miscellaneous duties as assigned and required to meet business needs in a highly professional manner.
- Experienced with interpreting electronic medical records (EHR).
- Multi-tasked effectively and worked independently in a remote setting.
- Maintained high coding standards for healthcare organizations.
Experience
2-5 Years
Level
Executive
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Summary : As a Medical Coding Auditor, tracked records of ensuring accuracy and compliance in medical coding practices, was expertised in coding audits, knowledge of healthcare regulations.
Skills : Problem-solving, Computer Skills.
Description :
- Conducted coding audits regularly to ensure compliance with coding guidelines, accuracy, and completeness.
- Provided feedback and education to coding staff based on audit findings to improve coding accuracy.
- Collaborated with coding team leads and managers to develop and implement corrective action plans.
- Stayed updated on changes in coding guidelines, regulations, and healthcare policies.
- Assisted in the development and delivery of coding training programs for coding staff.
- Objectively and accurately conducted coding reviews on medical records for assigned client audit contracts while meeting compliance, productivity, and quality expectations.
- Appropriately referred reviews for clinical validation.
Experience
10+ Years
Level
Senior
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Summary : As a Medical Coding Auditor, responsible for conducting regular audits of inpatient and outpatient medical records to validate code assignments, and responsible for collaborating with coding and billing teams to resolve coding-related issues and discrepancies.
Skills : Medical Coding, Auditing.
Description :
- Responsible for preparing and presenting audit reports to management, highlighting areas for improvement.
- Responsible for participating in coding compliance reviews and coding quality improvement initiatives.
- Responsible for assisting in the development of coding policies and procedures.
- Responsible for performing coding for various medical specialties, ensuring accurate code assignment.
- Responsible for assisting in coding audits and contributed to developing audit protocols.
- Responsible for collaborating with physicians and other healthcare professionals to clarify documentation and coding requirements.
- Responsible for staying current on coding updates and attending relevant workshops and seminars.
Experience
7-10 Years
Level
Management
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Headline : As a Medical Coding Auditor, tracked coding issues and reviewed coding inaccuracies to highlight areas of improvement, reported or resolved escalated issues as necessary.
Skills : Detail-oriented, Analytical Skills.
Description :
- Performed a comprehensive medical records review to ensure the presence of all parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports that appear to be indicated by the nature of the treatment rendered.
- Provided a high level of technical education and served as a subject matter specialist regarding coding and documentation.
- Supported and educated team members about coding best practices and procedures to meet compliance and regulatory requirements.
- Organized and prioritized work with minimum supervision.
- Performed most essential job duties independently and exercised good judgment.
- Demonstrated initiative and creativity in assigned work while constantly attempting to improve workflows.
- Monitored all coding accuracy at various levels of detail and maintained coding quality as needed.
Experience
5-7 Years
Level
Executive
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Objective : As a Medical Coding Auditor, reduced human resource and personnel security management issues through access to remote, highly skilled, nationally certified)) medical record coders.
Skills : Electronic health record, Coding software.
Description :
- Accessed the government’s system, MHS Genesis, JLV, and paper charts, and any new medical documentation system deployed by the MTF via secure systems (coding) that reside on the government network and allow for centralized data collection, reporting capabilities, Quality Assurance, and Workflow Management.
- Implemented solutions that re-engineer the current government process to accelerate records completion and the entire coding process.
- Focused on improving processes through a combination of coding from paper format health information onsite, and remote access to the MTF information systems.
- Supported and implemented the organization's vision, mission, and values.
- Maintained professional and technical knowledge by attending educational workshops.
- Reviewed professional publications, established personal networks, and participated in professional societies as necessary or required.
- Effectively communicated with providers/Coders to clarify diagnoses, procedure coding, and documentation requirements, including proper sequencing.
Experience
2-5 Years
Level
Executive
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Summary : As a Medical Coding Auditor, wrote a Letter of Rationale for providers, and met required productivity standards in both quantity and quality.
Skills : Healthcare regulations, Compliance reviews.
Description :
- Audited the contract coders and ensured their quality of work met the industry standards in coding.
- Responded to all audits conducted by either a Federal Agency or MTF Contracted Auditor
- Enhanced the prompt availability of patient information for providers, as well as accelerating the coding process.
- Reduced on-site revenue cycle management-related operating expenses.
- Improved data quality and increased coding quality through state-of-the-art systems and best practices recommendation and implementation.
- Implemented productivity-based support services for cost-effective operations.
- Improved revenue cycle financial operations efficiency and productivity.
Experience
10+ Years
Level
Senior
Education
Associate's Degree in Health Information Management
Medical Coding Auditor Resume
Objective : As a Medical Coding Auditor entered and updated all contract and/or review findings supporting documentation into the audit processing system, and wrote logic/parameters for system edits to detect incorrect coding overpayments, and aberrant and abusive coding patterns.
Skills : Strong written and verbal communication skills.
Description :
- Proofed concept development and data analysis of reports for potential edit development.
- Maintained current knowledge of all Medicare and Commercial regulations, policies, and procedures.
- Maintained certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certifications, as well as HIPPA and other compliance training provided by Performant.
- Developed and maintained professional working relationships within the department and cross-functionally.
- Performed coding audits to ensure compliance with established policies and procedures, laws, and government regulations.
- Improved Quality Assurance and centralized reporting capabilities.
- Obtained through a software system with at least a 128-bit encrypted (secure, HIPAA compliant) system.
Experience
2-5 Years
Level
Executive
Education
Associate's Degree in Health Information Management
