Position Description :
The Outpatient Coding Auditor is a member of the CGI Healthcare Payment Integrity Team with responsibility for rendering appropriate, well-supported, and thoroughly-documented decisions which may result in the identification of improper payments on paid claims to various providers of clinical services, including outpatient hospital, ambulatory surgical centers, Home Health and DME providers.
Your future duties and responsibilities :
Reviews medical records to identify recovery opportunities on claims for Outpatient and Professional and Allied Services
Correctly interprets and utilize reference materials, including coding standards and guidelines, CPT Assistant, Coding Clinic for Outpatient and client payment polices.
Provides ongoing input to the Edit Development team on claims selection criteria and new recovery concepts.
Complies with department standards regarding productivity and audit quality and performs other duties as assigned.
Completes training and education on audit processes, industry changes and other topics as needed.
Required qualifications to be successful in this role :
Registered Nurse (active / unrestricted) current AHIMA or AAPC credentials (RHIT or RHIA and CCS-P, CPC, or CPC-H / COC).
Minimum 3-5 years outpatient coding experience.
Extensive knowledge of ICD 9 / 10 and CPT / HCPCS coding and APC reimbursement.
Understanding of Medicare / Medicaid and Commercial provider reimbursement methodologies.
Solid working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word and Excel) and Windows operating systems.
The ability to write a well-reasoned review in a narrative style with correct spelling, grammar, punctuation and sentence structure is required for success in this position.
Amenable to work in mid and / or night schedule.
Temporary WFH (Office Location : Pasig / Taguig)