Billing Quality Coding Auditor

Job not on LinkedIn

🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

📋 Description

• Performs multi-specialty reviews for the Medical Group, validating CPT, ICD-10, modifiers, and HCPCS codes using official coding guidelines and CMS guidelines • Prepares summaries of coding review findings and presents reports to leadership monthly • Reviews all coders within the department and identifies opportunities for improvement • Provides training, mentoring, and guidance to coders on identified issues and correct coding guidelines • Codes professional billing charges based on clinical documentation review • Identifies and assists with resolving coding issues and process improvements • Assists in creating edits to prevent coding denials • Assists in creating standardized front-end coding processes and training materials • Interacts with other departments to resolve coding issues • Performs other duties as assigned

🎯 Requirements

• Bachelor's degree in Business or related field of study • Three (3) years of multi-specialty coding experience in professional billing • CPC Certified Professional Coder certification from AAPC • CPMA Certified Professional Medical Auditor certification from AAPC • Knowledge of medical terminology and basic anatomy and physiology • Ability to apply coding concepts to ensure correct coding • Analytical skills • Working knowledge of Epic, Encoder Pro, and 3M • Ability to work independently and manage multiple projects consistently • Proficient computer skills in word processing, spreadsheets, and databases • Data entry skills