Lead Profee Auditor
Reports To: Audit Manager, Advisory
Overview: The lead auditor will have the primary responsibility of being an expert resource to the Sr Director, Audit Mgr of Advisory Solution.
Duties and Responsibilities
· Performs daily profee audits for Advisory clients.
· Audits medical record documentation to identify under-coded and up-coded services; Ensures compliance with performing an "Audit the Auditor" process. The lead auditor will perform audits on the auditors to ensure ongoing accuracy and compliance.
· Manages audit workflow between auditors and clients (data uploads, communication between auditors and clients, etc.).
· Provides research and assistance with answering coding questions from Auditors and clients as needed.
· Provides and creates education for clients.
· Interacts with physicians and other patient care providers regarding coding and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
· Trains, instructs, and/or provides support to auditors' onboarding of new clients.
· Touchpoint meeting calls with clients to discuss audit progress.
· Assists with projects, as needed.
· Performs miscellaneous job-related duties, as assigned.
Minimum Job Requirements
· Two year HIM degree and 3 years of direct auditing experience or technical certificate in Medical Coding with at least 10 years of coding experience and 5 years of direct auditing experience
· CPC, CCS-P, RHIT, RHIA
· Expert knowledge of Medical Terminology, ICD-10/CPT-4 coding
· Educational development including internal and external presentations
· Good communication skills and ability to work with internal and external staff
· Intermediate knowledge of Microsoft Office – Outlook, Excel, Word and Power Point
Knowledge, Skills and Abilities Required
· Knowledge of auditing concepts and principles.
· Advanced knowledge of medical coding and billing systems and regulatory requirements.
· Ability to use independent judgment and to manage and impart confidential information.
· Ability to analyze and solve problems.
· 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.
· Ability to clearly communicate medical information to professional practitioners and/or the general public.
· 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 provide guidance and training to professional and technical staff in area of expertise.
Working Conditions and Physical Effort
· No or very limited physical effort required.
· No or very limited exposure to physical risk.
· Work is normally performed in a typical interior/office work environment.