Outpatient Coder Auditor
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Job Description
Outpatient Payment Integrity Coder Auditor responsible for auditing outpatient medical claims. Ensuring coding accuracy and compliance with CMS and payer guidelines.
Responsibilities:
- Perform detailed coding audits on outpatient facility claims to validate appropriate CPT/HCPCS, revenue codes, modifiers, and ICD-10 coding in accordance with CMS, NCCI, and payer-specific rules.
- Evaluate medical record documentation to ensure services are coded, billed, and reimbursed accurately.
- Identify and analyze payment integrity issues including overpayments, underpayments, and incorrect billing patterns.
- Collaborate with clinical, data analytics, and payment integrity teams to develop new outpatient claim review concepts and audit strategies.
- Provide education and feedback to internal teams or providers based on audit findings.
- Research and apply current CMS OPPS, APC, and EAPG guidelines to ensure compliant auditing practices.
- Document audit findings clearly and concisely, maintaining a high standard of accuracy and quality assurance.
- Contribute to the development and testing of audit tools, rule logic, and automated review concepts to enhance outpatient claim accuracy.
- Stay current with regulatory updates, coding changes, and payer policy revisions.
Requirements:
- Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or equivalent AHIMA certification (CCS).
- 3+ years of experience in outpatient facility coding, auditing, or payment integrity.
- Strong knowledge of CMS OPPS, APC, and EAPG payment methodologies.
- Proficiency in interpreting medical documentation and applying official coding guidelines.
- Excellent analytical, organizational, and written communication skills.
- Preferred: Experience with managed care organizations, commercial payer claim reviews, or payment integrity programs.
- Familiarity with data analytics tools and claim review platforms.
- Prior experience in payment integrity, and audit development strongly preferred.
- Expertise with reimbursement methodologies.
- Familiarity with data analytics and audit selection processes.
Benefits:
- Excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
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