Certified Coding Auditor

About North Country Healthcare (NCH):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve. As a leader in a management position this role emphasizes advancing High-Reliability Organization (HRO) principles, embedding a culture of safety, accountability, and consistent high performance.

POSITION SUMMARY:

Under the general direction of the Coding Supervisor, HIM Team Lead, HIM Manager or HIM Director, s responsible for reviewing and analyzing clinical documentation, coding accuracy, and billing compliance for healthcare services. The auditor ensures that medical coding and documentation meet regulatory requirements, internal policies, and industry standards. This role plays a crucial part in identifying potential coding errors, providing feedback to improve documentation practices, and helping mitigate financial and compliance errors.

ESSENTIAL QUALIFICATIONS

Education:

• High School Diploma or equivalent, Associate Degree in medical Coding or Related Field preferred.

Certification:

• Required active coding credentials: CCS, CCS-P, CPC, CDIP, RHIT and/or
  RHIA. CPMA preferred.

• No specific licensure is required.
• Association* accredited course in Basic Life Support (BLS) (for clinical staff), or Heartsaver CPR AED (for nonclinical staff), and renewal on a regular basis, with up to a three-month grace period after the expiration date.

Skills:

• Analytical & critical thinking to identify trends and patterns for improvement.
• Attention to detail & accuracy of coding.
• Understanding of healthcare reimbursement.
• Excellent oral and written communications skills
• Knowledge of Microsoft Office software: Excel and Word
• Extensive knowledge of medical terminology and ability to research coding related questions.

• 5+ years inpatient and outpatient auditing experience with an acute care facility, experience with CPT/ICD-10 CM-PCS/HCPCS/modifier, E & M coding for hospital/office encounters.

ESSENTIAL FUNCTIONS:

1. Conduct Coding Audits: Review patient records, charts, and coding data to ensure accuracy, completeness, and compliance with ICD-10, CPT, HCPCS, and payer-specific guidelines.

2. Identify Errors & Recommend Corrections: Identify discrepancies, coding errors, or documentation gaps and work with providers and coding staff to correct them.

3. Provide recommendations to improve accuracy and reduce errors in future documentation.

4. Ensure that coding practices comply with federal & state regulations, payer requirements & internal organizational policies to minimize risk.

5. Provide guidance, education, and training to coders and clinical staff on coding practices, regulatory changes, and documentation improvements.

6. Document audit findings, prepare detailed reports, including recommendations for corrective action.

7. Track & monitor trends in coding errors, denial rates & compliance issues.

8. Work closely with clinical staff, coding teams, and management to ensure proper documentation and coding practices.

9. Act as a liaison to resolve coding-related issues.

10. Stay informed about updates to coding systems (ICD-10, CPT, etc.), payer policies, & regulatory requirements.

11. Ensure the coding practices align with industry standards.

12. participate in quality assurance initiatives to enhance coding accuracy, reduce rework, and maintain optimal revenue cycle performance.

13. Maintains work area in a clean and orderly manner.

14. Maintains familiarity and operation of all office equipment necessary to perform duties.