Certified Professional Medical Coding Auditor

🕒 September 4

🇺🇸 United States – Remote

💵 $75k - $95k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 37%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 69 days.
• Jobs at this company usually fill in 21 days.
• Reposted once.

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Tegria

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2020

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

Tegria is a global healthcare consulting and services company that partners with provider and payer organizations to advance care, improve performance, and tackle the biggest challenges in healthcare. They offer a range of services including patient access optimization, data analytics, cloud solutions, and revenue cycle transformation to create value and enhance healthcare delivery. Tegria focuses on streamlining operations, fostering innovation, and leveraging technology to maximize performance and improve patient experiences.

📋 Description

• Evaluate the accuracy, consistency, and quality of coded medical records completed by internal and external coding staff • Conduct routine monthly, retrospective, concurrent, and targeted coding audits according to established plans and methodologies • Audit ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and modifier codes • Evaluate coding accuracy, completeness, consistency, and compliance with official guidelines and organizational standards • Validate code assignment and sequencing based on provider documentation • Resolve routine coding questions and escalate complex or ambiguous issues • Identify coding errors, trends, improvement opportunities, compliance concerns, and revenue concerns • Monitor coding quality metrics and support scorecard development and reporting • Participate in quality improvement initiatives • Provide timely, constructive, individualized feedback to coders • Translate audit findings and trends into education topics and identify developmental needs • Help deliver coding education sessions and create tip sheets, guidance documents, case studies, and training materials • Assist with onboarding and mentoring newly hired coders • Support corrective action plans and individualized education plans • Serve as a coding resource for staff and assist with complex coding questions • Monitor regulatory and coding guideline changes and communicate their impact • Assist with internal and external coding quality reviews and organizational compliance initiatives • Analyze audit data and prepare audit reports and coding quality metrics with supporting documentation • Track coder performance improvement and measure educational intervention effectiveness • Recommend workflow improvements and process standardization • Partner with the Coding Manager and Coding Leads on audit findings, education, and coder development • Contribute to coding policy and procedure development • Leverage approved AI tools to enhance productivity, accuracy, and decision-making • Perform other generally related duties as assigned

🎯 Requirements

• High school diploma or equivalent required • Associate or Bachelor's degree in Health Information Management or related healthcare field preferred • Current Certified Professional Medical Auditor (CPMA) certification • One of the following AAPC or AHIMA certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), RHIT, or RHIA • Minimum 3 years of medical coding experience in professional and/or facility coding • Minimum 1 year of coding quality review, auditing, or coding education experience • Ability to work with general direction and exercise sound judgment on coding issues • Strong working knowledge of ICD-10-CM, CPT, HCPCS Level II, ICD-10-PCS, and official coding guidelines • Solid understanding of coding quality methodologies and audit principles • W2 project-based consultants must provide a computing device adhering to industry standards and security best practices • Ability to be productive, responsive, and reliable in a remote working environment • Ability to exercise sound, independent judgment on ambiguous or complex coding issues • Objectivity and consistency in evaluating others' work • Clear and constructive communication when delivering critical feedback • Ability to stay current as coding guidelines and regulations evolve • Strong attention to detail and trend-level thinking • Ability to manage competing priorities and deadlines • Patience and constructive mindset for coaching and development • Ownership and follow-through on outcomes

🏖️ Benefits

• Multiple health and dental plans with nationally recognized networks • Vision benefits • Total wellness program • Employee assistance program for employee and family • Retirement savings plans • Company-paid disability and life insurance • Pre-tax savings opportunities (HSA and/or FSA) • Professional development offerings • Opportunities for remote work • Generous paid-time-off program • Flexible scheduling to accommodate unexpected events

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