SIU Code Auditor
$87,500–$87,500 year
On-siteWorcester, Massachusetts, United States
Job Summary
Review medical records to verify coding accuracy for E&M, DME, home health, and behavioral health services using ICD-10, CPT, and HCPCS guidelines. Identify aberrant billing patterns, potential fraud, waste, and abuse, and support investigations by analyzing clinical summaries and provider documentation. Communicate findings to internal and external stakeholders, recommend providers for further review, and assist with claim denial reporting and regulatory agency complaints. Manage daily case assignments, maintain departmental documentation standards, and collaborate with clinical teams and Medical Directors to resolve billing issues.
Required Qualifications
- Bachelor's degree preferred or equivalent experience
- Prior experience in healthcare
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Clinical Experience
- Certified Evaluation and Management Coder (CEMC)
- Certified Professional Medical Auditor (CPMA)
- 3-4 years of relevant experience
- Demonstrated proficiency in medical record audits and analysis
- ICD-10CM/CPT coding methodology
- HCPCS Coding systems and guidelines
- Knowledge and understanding of medical terminology
- Knowledge of billing and other coding edits
- Centers for Medicare and Medicaid Services (CMS) local and national coverage determinations
- Managed billing regulations
- Strong quantitative skills
- Strong analytical skills
- Strong interpersonal skills
- Strong written skills
- Strong communication skills
- Understanding in fraud, waste abuse regulations
Desired Qualifications
- Clinical Experience
- Certified Evaluation and Management Coder (CEMC)
- Certified Professional Medical Auditor (CPMA)
- Understanding in fraud, waste abuse regulations, or any combination of education and experience, which would provide an equivalent background
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.