Position Summary

The role of the Profee Coding Auditor reports to the Profee Audit Manager. This position is responsible for chart reviews of medical records for clinic, outpatient, and inpatient provider claims. The position is responsible for management, implementation, and delivery of assigned audit phases, including planning, fieldwork, and reporting.

Essential Position Responsibilities

• Conduct focused chart reviews, audits, risk adjustment and compliance reviews on providers and clinics, as directed by management, tracking results and identifying trends and deficiencies for follow up training for providers and coders, as necessary.
• Report concise and detailed recommendations to improve documentation of E/M services, CPT, specificity of ICD10 codes and RAF scores.
• Provide timely identification of deficiencies and educational needs to providers and coders.
• Support coders by performing quality assurance reviews and providing appropriate education.
• Create educational material and present training to providers and coders, as needed.
• Independently, or as directed, research complex coding, E/M services, Procedural Coding, documentation requirements and HCC issues and remain knowledgeable of coding and compliance changes as communicated by CMS, HHS, AHA, AMA, Federal Register, and third-party contracts.
• Participate in PTT and other provider meetings, as needed.
• Protect data integrity and validity.

Qualifications

• Education: High school diploma or GED, required. Associates degree in related field or equivalent experience
• Licensure and Certifications: CPC, CRC or other comparable coding credentials required.
• Experience: 3-5 years of auditing experience. Thorough understanding of Risk Adjustment, HCCS coding, ICD coding, HEDIS, and CPT coding. Excellent communication, presentation, and analytical skills.

Work Environment: This position will spend 90+% of the time sitting while performing work in a standard office environment.