Job Description:

El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen.

FTE

1

Scheduled Bi-Weekly Hours

80

Work Shift

Day: 8 hours

Job Description

The Professional Coding Auditor conducts complex audits for clinic based providers to ensure selected coded data, Evaluation and Management, and charge assignments are compliant with Official Coding Guidelines in ICD-10-CM coding conventions and CPT/HCPCS coding conventions. The role of the auditor is to educate physicians to ensure that data within the legal medical record is coded efficiently and accurately for appropriate reimbursement and medical necessity to meet regulatory accreditation requirements for state and federal reporting. Acts as liaison and works in conjunction with Patient Financial and Revenue Cycle teams to ensure coded data meets the national standards through collaborative discussion and with direct physician education. Provides physician specific education based on the quality monitoring of claim denials and trends. Reconciles hospital base admissions for surgical charge-entry with appropriate CPT and modifier assignments in conjunction of global days in mitigating claim denials and unbundle reporting. Participates in clinic base onsite training and meetings at various clinic locations and provides general coding coverage and other duties when necessary. QUALIFICATIONS:1. College level coursework in ICD-10-CM and CPT coding, anatomy and physiology, and medical terminology2. Minimum of three years' experience in auditing and claim denial reviews in acute clinic and hospital setting 3. Strong training background in outpatient clinic setting with direct 1:1 physician education, preferred 4. Minimum five years' experience of coding and demonstrating knowledge in the principals and practices of ICD-10-CM and CPT conventions with clinic visits and hospital surgical coding.5. Strong communication both oral, written and organizational skills6. Proficiency with Excel, Word, and Outlook7. Demonstrated ability to work productively, accurately, and independently8. Proven analytical and problem solving skills in compiling statistical data and state reporting 9. Comprehensive mastery of APC assignment methodology with emphasis in NCCI edits10. Ability to interact well with all levels of employees and physicians throughout the organization, participate in intra- and interdepartmental collaboration, and handle multiple tasks concurrently to meet deadlines.11. Technical aptitude for resolving basic PC hardware and software application problems and ability to perform basic troubleshooting License/Certification/Registration Requirements1. Certified Professional Coder (CPC) 2. AHIMA Certified Coding Specialist (CCS) credential, preferred

The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)

An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.

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