Professional Coder – Auditor - TMCOne - Remote

SUMMARY:

The Professional Coder Revenue Cycle Auditor reviews medical records and billing documents before and after payments to ensure accurate charges and proper billing. They use audit results for quality scoring and coder education, support external audits, and educate clinical staff on audit results.

ESSENTIAL FUNCTIONS:

• Review and audit medical charts and claims for accuracy.
• Educate coders and providers on billing and coding compliance.
• Assist departments with billing issues and denials.
• Support external audits and special projects.
• Develop and update policies related to audits and revenue cycle.
• Monitor industry trends and advise leadership.
• Prepare reports to help management make decisions.
• Ensure compliance with state and federal regulations.
• Help with hiring, training, and evaluating staff.
• Maintain confidentiality and follow safety standards.
• Perform related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  High school diploma or GED required; additional training in medical terminology or office administration preferred.

EXPERIENCE: Three (3) years of hospital or physician billing required.  Two (2) years of auditing experience required.

LICENSURE OR CERTIFICATION:   Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required.

KNOWLEDGE, SKILLS, AND ABILITIES:

·         Strong medical coding (ICD, CPT).

·         Strong attention to detail and accuracy in data entry.

·         Effective communication and customer service skills.

·         Ability to analyze performance and suggest improvements.

·         Organizational skills to manage multiple tasks and maintain documentation.

·         Ability to work independently and as part of a team in a fast-paced environment.

·         Expert knowledge of medical terminology, coding guidelines, and payer regulations

·         Strong leadership, analytical, and mentoring abilities

·         Proficiency with EMR systems, billing software, and Microsoft Office

·         Strategic thinking and process improvement capabilities

·         Experience with HIM, billing systems, denials, and financial analysis.