Company Overview
About the job
Overview:
The auditor is responsible for reviewing and analyzing medical records for inpatient, outpatient, and professional orthopedic services to assess diagnoses and procedure codes as documented by the provider(s). This role involves performing revenue audit functions and requires a broad knowledge of the revenue cycle and compliance structure as outlined by the Federal Sentencing Guidelines. The auditor supports appropriate reimbursement and ensures compliance with governmental billing regulations specific to the orthopedic specialty.
This position works closely with a multidisciplinary team to facilitate compliant processes and present complex revenue data to support operational and strategic decision-making. The auditor also provides compliance support across the revenue cycle, including oversight of quarterly RVU reports, physician incentive requirements, and preparation of annual audit schedules. Additionally, the auditor prepares reports of findings and educates providers and coders on accurate coding practices and compliance issues.
Qualifications:
- Education: High school diploma
- Experience: At least 5 years of coding experience in ICD-9-CM diagnosis/procedure coding and HCPCS/CPT procedure coding, specifically in orthopedic or similar professional services settings, or 5 years of experience in healthcare coding and compliance activities
- Certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified in Healthcare Compliance (CHC)
- Preferred Education: Associate’s or Bachelor’s degree from an accredited Health Information Technology or Health Information Management program
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