Certified Professional Coder

Job Summary:
This position is responsible for leading on-site and desk audits of hospital billing and coding practices, including forms development, audit profiling, and tracking institutional audit trends. The role involves designing audit protocols, handling special projects, and performing/finalizing per diem audits, bill verification, DRG validation (utilization review audits), and credit balance reviews. The position also provides education and guidance on ICD-10-CM coding, DRG assignment, payment methodologies, and auditing practices.

Key Responsibilities:

• Lead hospital billing and coding audits, both on-site and remote
• Identify and present billing discrepancies and coordinate improper claim payment referrals
• Analyze trends related to documentation, billing errors, and provider contract interpretation issues
• Compile audit reports, statistics, and findings for internal teams and regulatory agencies
• Review and enhance audit processes to align with clinical review innovations and cost-containment initiatives
• Train and mentor new staff on departmental audit procedures
• Ensure compliance with healthcare laws, regulations, and company policies
• Support special projects and additional assignments as requested by management

Education & Experience:

• High School Diploma/GED required
• Bachelors Degree in Health Information Management preferred or equivalent relevant experience
• Minimum 3 years of experience in a medical records department within an acute care hospital or healthcare setting
• Experience with DRG validation, ICD-10-CM training, and healthcare auditing required

Required Certifications & Licensure:

• Active RN License required
• CCS or RHIT/RHIA Certification required

Preferred Certifications:

• CCS
• CCS-P
• CCA

Preferred Knowledge:

• Experience with ACCESS Software preferred