OP Auditor

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Duties/Responsibilities:

• Provide client services and lead, coordinate, and perform all functions of quality reviews for outpatient coding across multiple clients. 
• Performs quality reviews on coders ensuring compliance with coding guidelines and company policies for complete, accurate, and consistent coding.
• Reviews include Outpatient ICD-10, CPT, APC, CPT Modifiers, ED E&M and professional coding and E&M assignments.   
• Knowledge expert and maintains up-to-date working knowledge of coding guidelines in order to act as a resource and point person for issues and question for coders, customers or project teams. 
• Provides education to audit clients or internal eCatalyst coders as required by the deliverables of the contract.
• Reviews physician documentation for coding appropriateness and accuracy following coding guidelines.
• Facility OP auditing including Same Day Surgery, Observation, ED, and Ancillary visit types. Profee multi-specialty experience is a plus.
• Provides feedback to coders and providers on coding corrections, appropriately citing authoritative resources.
• Assists with the interpretation of codes and other information requested for accurate code assignment.
• Communicate with management regarding clinical, coding, and reimbursement issues as needed.
• Function in a professional, efficient, and positive manner with strong critical thinking and decision-making skills.

• Utilizes our client’s electronic medical record (EMR), encoder, and computer-assisted coding (CAC) software as directed.
• Ensures optimal reimbursement while maintaining compliance with CMS and third-party payor policies and guidelines. 
• Maintains compliance with client’s coding policies, procedures, and guidelines.

• Consistently maintains 95% or above accuracy rate while meeting established productivity standards.
• Completes daily production log and daily time keeping requirements. 
• Attends and participates in client meetings as requested.
• Completes coding continuing education and maintains auditing credentials. 
• Ensures HIPAA compliance at all times.

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