JOB DESCRIPTION

The Coding Auditor provides analysis of coded medical services, reports, records, and billed charges to determine appropriateness of the medical coding utilized. The Coding Auditor will use their expertise in operative report abstracting, unlisted code analysis, and advanced appeal concepts to perform secondary coding reviews.

Key Responsibilities:

• Conducts coding audits of submitted claims to determine appropriateness of procedure code, ICD code, and HCPCS code based on documentation provided for ASC claims, when coding review is requested.
• Coordinates with revenue cycle teams to investigate rejected or denied claims to determine denial accuracy and work in an inter-departmental collaboration process to assist in claim corrections/appeals.
• Assists manager with special projects / other tasks as assigned.
• Drafts appeal to payors using nationally sourced coding guidelines such as CPT Assistant, AHA Coding Clinic, specialty societies, state fee schedule language, AAPC / AHIMA Articles, etc.
• Reviews carrier audit for appropriateness of coding and assists with any appeals.
• Meetings with clients (Centers), CBO, Revenue cycle management teams, internal coding departments.
• On days where the workload is light, the Coding Review Specialist may be asked to assist with production coding for the Central Coding Department.
• Expected review production volumes for an 8-hour shift are 20-24 cases averaging around 20 minutes per case.
• Expected review production volumes a 10-hour shift are 26-30 cases averaging around 20 minutes per case.

REQUIRED

• High school diploma or equivalent (Associate’s or Bachelor's degree preferred).
• Required certifications: RHIT, RHIA, and/or CCS credential OR AAPC certifications (CPC, COC, CPMA)
• Minimum of 5 years of coding experience in a healthcare setting.
• Strong knowledge of coding guidelines (e.g., ICD-10, CM, CPT, HCPCS) and documentation requirements.
• Familiarity with regulatory requirements (e.g., HIPAA, Medicare, Medicaid) related to coding and documentation.
• Excellent attention to detail and analytical skills to identify coding errors and compliance issues.
• Strong communication and interpersonal skills to collaborate effectively with coding team members and healthcare providers.
• Proficient in using coding software, electronic health record (EHR) systems, and other relevant tools.
• Ability to adapt to changing coding guidelines, regulations, and organizational policies.
• Strong organizational and time management skills to prioritize and manage multiple audits and projects concurrently.

COMPENSATION

• Pay: $30.60 to $48.80 hourly. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

BENEFITS

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, AD&D and life insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

#LI-DM2

Tenet Healthcare/USPI complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.