Outpatient Coding Auditor

Outpatient Coding Auditor

Position Description
Job Summary
The Outpatient Coding Auditor is a member of the CGI Healthcare Payment Integrity Team with responsibility for rendering appropriate, well supported, and thoroughly documented decisions which may result in the identification of improper payments on paid claims to various providers of clinical services, including outpatient hospital, ambulatory surgical centers, Home Health and DME providers.
Ongoing training and education are provided specifically for the audit processes, industry changes and other topics as needed. In addition to coding and reimbursement expertise, this remote position requires a self motivated, organized, detail oriented person with superior critical thinking, problem solving and communication skills.
Qualifications

. Current AHIMA or AAPC credentials (RHIT or RHIA and CCS P, CPC, or CPC H/COC)
. Extensive knowledge of ICD 10 and CPT/HCPCS coding guidelines and appropriate use of modifiers.
. Minimum 5 years outpatient/surgical coding experience.
. Understanding of Medicare/Medicaid and Commercial provider reimbursement methodologies.

Preferred Qualifications

. At least 5 years of experience.
. AHIMA or AAPC credentials (RHIT or RHIA and CCS P, CPC, or CPC H/COC).
. Experience coding specialty surgical areas including orthopedics, cardiology, spine and back, and/or interventional radiology is highly desired.
. Extensive knowledge of ICD 10, CPT/HCPCS coding and APC reimbursement.
. Understanding of Medicare/Medicaid and Commercial provider reimbursement methodologies.
. Should have experience working with an encoder, preferably Trucode, and be accustomed to reviewing medical records remotely.

Your future duties and responsibilities

Required qualifications to be successful in this role

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