Medical Coder Auditor-HIM Coding & CDI Quality

$58,011 - $83,387/Yr

UNC Health - Chapel Hill, NC

Full-time - Mid Level

Hybrid - Chapel Hill, NC

10,001+ employees

Ambulatory Health Care Services

About the position

This position is responsible for training and auditing medical coders across various HCS entities, ensuring compliance with coding standards and regulations. The role involves mentoring new staff, providing ongoing training, processing insurance coding denials, and analyzing coded records for compliance. The position aims to improve coding accuracy and maximize reimbursement while educating physicians and staff on error trends.

Responsibilities

• Audits inpatient and outpatient medical coders to assure a minimum of 95% accuracy and recommends education and training related to results.
• Assigns and/or audits IP and OP Coders assignment of ICD-10 diagnostic and procedural codes, CPT codes with modifiers, and other applicable codes accurately.
• Faxes, tracks, and monitors coding denials and appeals on both inpatient and outpatient cases.
• Resolves insurance denials that have been accepted by updating the coding and sending for rebilling if required.
• Generates coding appeals for insurance denials with sound arguments based on coding guidelines and conventions.
• Coordinates Peer to Peer requests with third party payers and CDI Physician Advisors and prepares for meetings.
• Researches and resolves problems referred by coders and provides prompt feedback.
• Provides input on performance of coders and audit information to supervisor for performance evaluations.
• Educates physicians and other health care staff regarding current coding practices and changes in regulations and guidelines.
• Provides training and serves as a general resource to assist other coders and department staff.
• Participates in and provides education sessions on specific coding topics at huddle meetings and other forums.
• Reviews, analyzes, and abstracts physician/other documentation for diagnoses, procedures, and services provided.
• Communicates with physicians and other health care staff to obtain missing information or clarify existing information.
• Reviews edits generated from PWC SMART software, resolves, and educates coding staff.
• Utilizes various software to compile and validate medical information.

Requirements

• Associate degree in Health Information Management or related field or an equivalent combination of education, training, and experience.
• Successful completion of the UNC HCS IP or OP Coder Proficiency Test as applicable.
• Must have AHIMA or AAPC certification and credential.
• If associate's degree: Five (5) years of experience in medical coding or acute care consisting of both IP and OP coding.
• If High School Diploma: Nine (9) years of experience in medical coding or acute care consisting of both IP and OP coding.
• Strong knowledge of ICD-10/PCS/CPT/HCPCS coding and billing compliance with excellent analytical and data mining skills.
• Ability to effectively participate and supervise projects, plan and implement programs, and evaluate outcomes.
• Strong communication skills, both written and verbal.
• Effective organizational skills, time management, and management of multiple priorities.

Nice-to-haves

• Experience with Optum, Epic, PWC SMART, MS Office, Audit Manager software.
• Ability to make effective and persuasive presentations on complex topics to management and physicians.
• Experience in teaching and mentoring coders and physicians on complex coding systems.

Benefits

• Health insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• 401k retirement savings plan
• Paid holidays
• Flexible scheduling options
• Professional development opportunities