Cherokee Nation Businesses

Title: Medical Coding Auditor

Location: Fort Campbell US-KY US


Job Description:
Remote Medical Coding Auditor – Nationwide

Cherokee Nation Healthcare Services’ business consultants are experts in providing comprehensive advisory and assistance and health care solutions for hospitals, clinics, and military treatment facilities throughout the United States and Guam. CNHS has leveraged mission-critical demand with results-driven excellence for the past 10 years, and continue to do so. CNHS and its partners can provide robust solutions for your evolving needs.

As a tribal 8(a), SBA certified firm, and an unlimited sole source provider to customers, we have a wealth of knowledge and expertise at our disposal. Wholly owned by the Cherokee Nation, CNHS’s strong financial support, extensive past performance history and emphasis on quality management expertise allows the company to offer a truly unique value proposition to support any size client base. Large or small, federal or commercial, we are responsive to the mission at hand. CNHS serves customers in more than 27 states and three countries.

Because we represent both Cherokee Nation Businesses and the small business community, it is our intent to serve our customer and provide the best consultants, health care providers, program managers and to do so with integrity.

Responsible for the auditing of medical documentation and codes for compliance with federal coding regulations and guidelines. This will include the assignment of ICD, Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes, modifiers, and quantities as documented by the physician. Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities.

Remote Medical Coding Auditor

Essential Duties and Responsibilities

  • Candidate audits medical record documentation to identify inaccurate coding services; prepares reports of findings and meets with providers and medical coders to provide education and training on accurate coding practices and compliance issues.
  • Provides second-level review of outpatient coding assignment for billing purposes to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  • Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
  • Interacts with MTF staff regarding coding rules, documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
  • Trains, instructs, and/or provides technical support to MTF staff and medical coders/reviewers/trainers as appropriate regarding coding compliance documentation, and regulatory provisions.
  • Trains, educates and informs providers and MTF staff through informational coding sessions, workshops, and in-house training/briefings in accordance with the AFMOA Coding Program Office business rules.
  • Ensures strict confidentiality of medical records and audit findings.

Supervisory/Management Authority

  • This position will not have supervisory authority.

Education and/or Experience

  • Ambulatory Auditor Certifications. Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Coder Specialist-Physician (CCS-P), and/or Certified Coder Specialist (CCS) are acceptable with a minimum of 5 years medical coding experience (encompassing multiple clinical specialties) and 3 years of medical auditing experience within the last eight years is required.
  • The candidates possessing a Certified Professional Medical Auditor (CPMA) certification must have a minimum of 2 years medical auditing experience within the last 5 years of medical coding experience (encompassing multiple clinical specialties).
  • Annual coding credentials must be maintained.
  • Required to maintain continuing education units (CEU) in accordance with the American Health Information Management Association and/or the American Academy of Professional Coders standards.
  • Prior leadership/supervisory experience required.
  • Public trust clearance

Knowledge, Skills and Abilities

  • Mandatory knowledge and skills.
  • Knowledge of auditing concepts and principles.
  • Advanced knowledge of medical coding and billing systems and regulatory requirements.
  • Strong communication and interpersonal skills.
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
  • Knowledge of current and developing issues and trends in medical coding procedures requirements
  • Detailed knowledge of medical coding systems, procedures, and documentation requirements.
  • Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
  • Ability to clearly communicate medical information to professional practitioners and/or the general public.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to analyze and solve problems
  • Ability to provide guidance and training to professional and technical staff in area of expertise
  • Computer literate, with knowledge of coding and auditing packages, mainframe and office software applications

Work Environment

  • Work will be provided in a climate controlled office environment