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Job Summary

The Coding/HCC (Hierarchical Condition Category) Auditor is responsible for reviewing medical records and associated documentation to ensure accurate and proper documentation related to coding of ICD-10, HCC, CPT, CPT2 and HCPC codes. The Auditor will identify errors, discrepancies, and areas for improvement in coding, billing, and documentation processes. This role often involves providing education and training to coding staff, providers and contributing to improvement initiatives related to charge capture process.In addition, this position will act as a quality control specialist, ensuring the accuracy and compliance of medical coding practices, particularly within the surgical and related professional services billing realm. 

This position supports the Frederick Health mission, vision, core values and customer service philosophy and adheres to the Frederick Health Compliance Program, including following all regulatory requirements and the Frederick Health Standards of Behavior.

Essential Functions:

• Reviewing Medical Records:

Examining medical charts and documentation to verify the accuracy of CPT, ICD-10, HCC, HCPCS codes, and modifiers assigned to surgical procedures and related professional services. 

• Ensuring Compliance:

Verifying adherence to healthcare regulations, payer-specific guidelines, and industry standards, including  and  regulations. 

• Identifying and Correcting Errors:

Detecting discrepancies, coding errors, and documentation deficiencies, and collaborating with coding staff to implement corrections and improvements. 

• Providing Education and Training:

Delivering training to coding staff on best practices, coding updates, and compliance requirements, often through workshops, seminars, and individual feedback. 

• Reporting and Analysis:

Preparing detailed audit reports, analyzing trends, and presenting findings to management and relevant stakeholders. 

• Policy Development:

Assisting in the development and maintenance of coding policies, procedures, and guidelines. 

• Collaboration:

Working closely with various departments, including billing, compliance, and clinical teams, to ensure seamless coding and billing processes. 

Required Knowledge, Skills and Abilities:

• Expert Knowledge of Coding:

Deep understanding of ICD-10-CM, HCC, CPT, and HCPCS coding systems, including modifiers and coding guidelines. 

• Clinical Documentation Expertise:

Ability to interpret medical records and understand clinical documentation requirements. 

• Regulatory Knowledge:

Familiarity with healthcare regulations, including HIPAA, CMS, and payer-specific requirements. 

• Analytical and Problem-Solving Skills:

Ability to identify patterns, analyze data, and develop solutions to coding-related issues. 

• Communication and Interpersonal Skills:

Effective communication skills to provide feedback, deliver training, and collaborate with various stakeholders. 

• Attention to Detail:
• Meticulous attention to detail to ensure accuracy in coding and documentation review

Minimum Education, Training, and Experience Required:

·5 to 10 years of experience in medical practice, hospital, or clinic setting.

·Certified Professional Coder (CPC) required

·Certified Professional Medical Auditor (CPMA) required

·Experience in Medical Coding Audit and Physician Education, preferably in Surgery Coding

• CCS/CPC/CPC-H/CIC/COC certification from AAPC /AHIMA would be a plus
• Current certification with valid proof of certifications
• Good knowledge of medical and billing systems, regulatory requirements, auditing concepts, and principles

Caring for you as you care for the CommUNITY
Frederick Health offers a comprehensive and affordable benefits package. Health, Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and offer multiple plans to best meet you and your family needs. Life insurance, Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees. Frederick Health offers a robust Paid Time Off program for eligible employees. Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees. All employees have access to free financial planning sessions. We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.

Pay is based on experience, skills and education.  Exempt positions under the Fair Labor Standard Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates.  The pay range may also vary within the stated range based on specialty if applicable. Non-Exempt positions may have shift differential and/or Overtime paid, if applicable.

Pay range: $28.00-$41.00

Hours: 8:00am-4:30pm, Monday-Friday.