Outpatient Coding Enterprise Auditor- Remote

Enterprise Auditor, Outpatient Coding

The Outpatient Coding Enterprise Auditor is an experienced auditor and certified professional coder with extensive knowledge of outpatient coding and auditing for various specialties, dedicated to ensuring the highest standards of coding accuracy and compliance. This position is critical for maintaining the integrity of coded data and the associated reimbursement. The ideal candidate will possess advanced knowledge of E/M and CPT coding concepts including same day surgery, with exceptional attention to detail, and the ability to collaborate effectively with various internal teams to drive continuous improvement in coding practices. The performance of data analytics on coded data is required to identify trends and patterns in coding errors.

Job Purpose
• Collaborate with internal staff to enhance documentation, coding, and compliance.
• Review and assess coding quality on accounts completed by Medical Coders.
• Review clinical documentation to ensure it supports the codes assigned and meets necessary documentation standards.
• Ensure adherence to workflows and ethical coding standards.
• Utilize advanced knowledge of ICD-10-CM coding concepts.
• Communicate review findings and recommendations to management.
• Assess risk and obtain necessary statistics for coding areas.

Duties and Responsibilities
• Administer the Quality Monitoring Program to meet quality standards and targets.
• Manage daily operational processes for quality, efficiency, and productivity.
• Utilize data analytics to identify trends and patterns in coding errors, proactively addressing issues, and improving overall coding quality.
• Collaborate with workgroups to resolve customer-impacting issues.
• Seek continuous improvement and development opportunities for the team.
• Address complaints, questions, and queries, as necessary.
• Document team members’ performance and targets.
• Monitor systems for optimal performance.
• Stay updated on guideline changes, laws, and regulations affecting documentation and reimbursement.
• Promote teamwork and service excellence within the department.
• Participate in performance improvement activities.
• Establish and maintain a formalized review process for compliance with contractual agreements on accuracy rates.

Specific Job Functions
• Recommend strategies to achieve high compliance with quality management plans.
• Participate in calls/meetings to address performance and training improvements.
• Assist in training sessions for new hires and provide refresher training as needed.
• Ensure compliance with all Med-Metrix policies and procedures.
• Identify high-risk areas in coding and develop strategies to mitigate these risks.
• Provide feedback to management on potential problems and improvement areas.
• Demonstrate exceptional attention to detail and accuracy in reviewing and analyzing medical records.
• Possess strong analytical skills to identify trends, patterns, and areas for improvement in coding practices.
• Handle patients' protected health information (PHI) in compliance with HIPAA standards.
• Ability to prioritize work and remain calm under pressure.

Qualifications
• Hold AAPC and/or AHIMA certification, with CPMA being advantageous.
• Minimum of 3-5 years of Coding and auditing.
• Equivalent work experience may be considered in lieu of professional credentials.
• Demonstrated knowledge of HIPAA in Medical Coding.
• Demonstrated knowledge and understanding of professional reference materials, such as Coding Guidelines and Coding Clinic
• Proficiency with Microsoft Word, Outlook, Excel, and PowerPoint
• Must be able to use job related software.
• Ability to work in a team environment and adapt to changing responsibilities.
• Strong verbal, written communication, interpersonal, and analytical skills.
• Self-starter capable of working independently and within a team.

Working Conditions
• Physical Demands: Occasionally move around the work area, sit, perform manual tasks, operate office equipment, extend arms, kneel, talk, and hear.
• Mental Demands: Follow directions, collaborate with others, and handle stress.
• Work Environment: Typically, minimal noise level.

This role is vital for ensuring the accuracy and compliance of coding practices, supporting the organization's goals for high-quality documentation and reimbursement processes.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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