Job Description

• Assist the Director of Compliance in creating and further coordinating the Compliance Audit Plan.
• Conduct internal billing and coding audits of medical record documentation and claims to identify coding errors.
• Prepare summary reports of findings and meet with physicians and staff to provide education and training on accurate and appropriate documentation practices.
• Research, analyze, and respond to inquiries regarding appropriate documentation and coding, denials, and billable services.
• Identify documentation gaps and develop processes for improvement.
• Collaborate with providers, Revenue Cycle department, Operations Directors and Managers, and others as appropriate, to coordinate billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation.
• Collaborate with providers, Revenue Cycle department, Operations Directors and Managers, and others as appropriate, to review and/or implement codes and to update charge documents.
• In certain instances, the Medical Coding Auditor-Educator will act as the liaison between the auditing vendor and Prism Vision Group in coordinating audits
• Perform miscellaneous job-related duties as assigned.

• High School diploma or GED.
• Certificate in Medical Coding (CPC or similar certificate from AAPC or AHIMA) or at least 2- 3 years of experience directly related to the duties and responsibilities specified.
• CPMA certification a plus but not required.
• Proficiency in or experience with General Ophthalmology and/or Retina coding and/or auditing strongly preferred but not required.

• Detail-oriented and organized.
• Proficient in Microsoft Office Suite software and Windows 10.
• Knowledge of auditing concepts and principles.
• Familiarity with or have experience with pulling electronic medical records and reports from the EMR and billing databases.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Ability to use independent judgment and to manage and impart confidential information.
• Strong communication and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation, including Medicare and Medicaid program rules
• Detailed knowledge of medical coding and billing systems, procedures, and documentation requirements.

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