Coding Auditor (ICD-10)

Position: Coding Auditor (ICD-10)

Duration: Full-Time 

Location: Newark/Wall NJ

Job Summary:

This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9- CM, ICD-10, DRG assignment payment and auditing.

Responsibilities:

• Identifies and presents billing discrepancies found during audit and coordinates referral of improper claim payments through the appropriate channels.

• Identifies error trends as they relate to medical record and or billing documentation or misinterpretation of provider contract stipulations.

• Compiles statistics and other audit information to present to accounts, regulatory agencies, and internal requesters.

• Reviews and updates audit processes with manager for purposes of keeping up with new innovations in clinical data review and company cost containment initiatives.

• Required to train new staff on department/audit procedures. 

• Performs other special assignments as requested by manager.

• Demonstrates knowledge, understanding and conforms to laws, regulations and policies that pertain to the organizational units business.

Knowledge:

• Requires knowledge of medical terminology, detailed knowledge of anatomy & physiology, disease pathogenesis and treatment including procedural drug therapies, ancillary and diagnostic services.

• Requires knowledge of principles of utilization management.

• Requires knowledge of hospital structures and payment systems.

• Requires knowledge of Centers of Medicare and Medicaid prospective payment system regulations. 

• Prefers knowledge of ACCESS Software.

• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.

• Must have strong PC skills experience with MICROSOFT office programs: excel, word and power point. 

• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.

• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.

• Proven ability to ask probing questions and obtain thorough and relevant information.

• Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.

• Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.

• Proven analytical, research and problem solving skills a must.

Travel (If Applicable):

• Field position: 85 to 90% of time spent in the field at various facilities in NJ, PA & NY