FQHC Coding Auditor Specialist (NOT REMOTE)
Location: D’Iberville, MS, 39540
Base Pay: $18.00 - $20.00 / Hour
Job Category: Facilities, Billing, Coding
Hours: Regular Full Time
Description **NOT REMOTE**
The Coding Auditor is responsible for all aspects of coding for Medical, Dental, Behavioral Health and Optometry claims in an FQHC setting. The Coding Auditor, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claim creation, follow-up, and correspondence with providers, third party payors and patients. The incumbent will assist in the clarification and development of process improvements and inquiries to maximize revenues.
Work is typically performed in an office environment, with participation in customer/community services activities as needed. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.
Knowledge, Skills, and Abilities
Prepares and submits provider audits on proper Dx and coding documentation.
Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations.
Work closely with team members regarding claim appeals, denials, resolution, and education.
Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to coding and billing. Updates business office staff, clinics, and faculty of changes as appropriate
Responsible for ensuring all providers are oriented to coding, billing, and documentation compliance.
Responsible for the continuing coding, billing, and documentation education for all providers and residents
Understands the considerations of coding in Value Based payment contracts.
Responsible for reviewing and implementing changes from payer bulletins.
Use online healthcare databases and other resources for eligibility verification and claim status.
Deliver the highest quality service to internal and external customers.
Assist other members of the team with projects as needed.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Proficient in Microsoft excel and PowerPoint.
Qualifications/Education Requirements
High school diploma or GED certificate required. 2 years in FQHC billing or 5 or more years in physician or hospital billing of accounts receivable. Experience in medical billing/coding preferred. Excellent computer skills and a familiarity with ADA, CPT, and ICD-10 coding is required. Certified Professional Coder (CPC) certification or Qualified Medical Coder (QMC) is required.
Core Competencies
Competent in both oral and written English.
Ability to read and interpret policies and procedures.
Processes and posts accounts receivable payments to patient accounts.
Posts insurance payments/adjustments for medical, dental, behavioral health, and optometry accurately on schedule.
Reconciles transaction activity.
Reviews private insurance claims for accuracy prior to submission to payers for payment.
Processes claims to payers in a timely manner.
Works denied claims by correcting and resubmitting claims to payers in a timely manner.
Provides technical and billing assistance to clinic staff as needed.
Communicates with staff, patients, payors and government intermediaries.
Assists HIT Trainers with electronic practice management and billing requests.
Competent in basic computer skills, including spreadsheets and business letters.
Competent in basic math, including calculation of ratios and percentages.
Upholds, complies with, and enforces the Core Principles and Code of Conduct
