Communicating audit results to appropriate parties; recommending corrective course of action.
Reviewing the claims materials and medical record information submitted and assessing accuracy of provider submitted claims.
Planning and conducting investigations for certain claims; identifying potential subrogation or fraud and engaging special investigate unit as needed.
Documenting audit results and supporting the development of audit policies and procedures.

Bachelor's Degree or equivalent work experience required
2 years of professional/ancillary or facility inpatient/outpatient coding and/or auditing experience in an applicable setting
Current AHIMA or AAPC coding certification preferably CPC or CCS
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Solid knowledge and understanding of provider reimbursement methodologies, ICD-10 CM/PCS, CPT, HCPCS and applicable billing requirements (CMS-1500 or UB-04)
Ability to handle confidential and sensitive information
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
Capacity to solve problems and manage multiple assignments with critical deadlines
Proven decision making and problem solving skills
Strong analytical skills
Positive attitude, self-driven, engaging, proactive, results driven.

Coding Auditor

Key skills