Coding Auditor

Overview:
Coding Auditor

PRINCIPAL DUTIES /
RESPONSIBILITIES
1. Conduct reviews of medical records and claims in support of fraud, waste and abuse investigations or for other program integrity initiatives.
2. Prepare written medical review summaries outlining rationale for claims determinations.
3. Conduct research in support of investigations.
4. Use knowledge of healthcare coding conventions, fraud schemes, areas of vulnerability, reimbursement methodologies, and relevant laws to help detect suspicious patterns in claims data, provider enrollment data, and other sources.
5. Maintain current knowledge of relevant regulations and standards, including, but not limited to, federal and state policies and coding guidelines.
6. Participates in special projects as required.

EDUCATION AND
**EXPERIENCE REQUIREMENTS**:
1. 2 - 5 years of related experience.
SKILLS / ABILIITES 1. Computer proficiency in MS Office suite.
2. Excellent verbal and written communication skills.
3. Strong listening and observation skills.
4. Attention to detail and high level of accuracy.
5. Effective organizational and prioritization skills with multi-tasking ability.
6. Ability to conduct research in support of medical review determinations.
7. Understanding of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and federal and state guidelines (including CMS NCCI).
8. Healthcare claims experience helpful
9. Works independently; collaborates well with peers and customers. 1. Computer proficiency in MS Office suite.
2. Excellent verbal and written communication skills.
3. Strong listening and observation skills.
4. Attention to detail and high level of accuracy.
5. Effective organizational and prioritization skills with multi-tasking ability.
6. Ability to conduct research in support of medical review determinations.
7. Thorough knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and federal and state guidelines (including CMS NCCI).
8. Proven ability to effectively handle cases of fraud and abuse in a discreet, confidential, and professional manner.
9. Knowledge of Medicaid and Medicare schemes strongly preferred
10. Provider education experience helpful.
11. Works independently; collaborates well with peers and customers.
1. Computer proficiency in MS Office suite.
2. Excellent verbal and written communication skills.
3. Strong listening and observation skills.
4. Attention to detail and high level of accuracy.
5. Effective organizational and prioritization skills with multi-tasking ability.
6. Ability to conduct research in support of medical review determinations.
7. Extensive knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and federal and state guidelines (including CMS NCCI).
8. Proven ability to effectively handle cases of fraud and abuse in a discreet, confidential, and professional manner.
9. Knowledge of Medicaid and Medicare schemes strongly preferred
10. Provider education experience helpful.
11. Works independently; collaborates well with peers and customers. 1. Computer proficiency in MS Office suite.
2. Excellent verbal and written communication skills.
3. Strong listening and observation skills.
4. Attention to detail and high level of accuracy.
5. Effective organizational and prioritization skills with multi-tasking ability.
6. Ability to conduct research in support of medical review determinations.
7. Extensive knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and federal and state guidelines (including CMS NCCI).
8. Proven ability to effectively handle cases of fraud and abuse in a discreet, confidential, and professional manner.
9. Knowledge of Medicaid and Medicare schemes strongly preferred
10. Provider education experience helpful.
11. Works independently; collaborates well with peers and customers.

REQUIRED QUALIFICATIONS 1. Certified Professional Coder (CPC) and/or Registered Nurse (RN)
2. Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
1. Certified Professional Coder (CPC) and/or Registered Nurse (RN)
2. Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
1. Certified Professional Coder (CPC) and/or Registered Nurse (RN)
2. Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
1. Certified Professional Coder (CPC) and/or Registered Nurse (RN)
2. Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program

PREFERRED QUALIFICATIONS
- Certified Professional Coder (CPC)