The HIM Professional Coding Auditor Lead serves as a subject matter expert in advanced elements of auditing of physician and clinician base charging and billing with extensive knowledge in ICD-10-CM diagnosis, CPT procedural assignment, and HCPCS Level II coding systems. Maintains extensive knowledge of CMS coverage policies and conducts research in the national database applications to support inpatient and outpatient services.  Supports El Camino Health professional fee charges with quality reviews ensuring billed services meet standards of reporting.

HIM Professional Coding Auditor Lead core duties:

• Monitors un-billed, claim edit, and denied claim reviews ensuring revenue metrics do not exceed claims submissions.

• Submits charge-master CPT and HCPCS procedures requiring charges with the use of revenue integrity applications and notification to team members in releasing charges.

• Leads educational sessions with the coding team by conducting research in various regulatory sites and coding guidelines in creating educational content for both clinicians and coding team members in reducing claim and payer denials.

• Extracts and uploads audited data from third-party vendors and coordinates other team members assignment in maintaining all monthly audits are completed in a timely manner.

• Primary educator with onsite and electronic format meetings for new and existing providers/clinicians.

• Supports both facility and professional lines with coding reviews and assist with coding facility backlogs as needed.

• Performs reviews of payer denials and track trends in providing monthly providers/clinicians education.

• Performs training of new and existing coding staff.

• Conducts internal and external auditing of coding staff team members by providing educational monthly reporting to reduce claim denials for ECHMN medical documentation by updating ECH Professional Coding Guidelines

• Performed other duties as assigned by the Coding management.

Qualifications

• Five (5) years’ experience with physician base billing including inpatient reporting.

• Advanced knowledge of CMS coverage policies and national coding edits.

• Proficiency in computer usage including analytical Microsoft tools i.e., spreadsheets, databases, presentation and word processing applications.

• Advanced knowledge of federal, state and private payer regulations.

License/Certification/Registration Requirements

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required

• Certified Professional Medical Auditor) CPMA preferred

Ages of Patients Served

This position will serve all age groups.