CODING AUDITOR RESUME EXAMPLE
Published: July 23, 2024 - The Coding Auditor reviews and approves the release of information for electronic submissions in response to Additional Documentation Requests from governmental and private payers. This position ensures compliance with regulatory, federal, and state billing requirements through meticulous reconciliation of the appeals process and conducts regular audits to maintain high standards in coding practices. This role is crucial for fostering cross-departmental relationships and providing continual education on industry standards to healthcare professionals, thereby enhancing the efficiency and accuracy of claim submissions.
Tips for Coding Auditor Skills and Responsibilities on a Resume
1. Coding Auditor, UnitedHealth Group, Minneapolis, MN
Job Summary:
- Review and ensure tasks assigned in the billing system are completed
- Maintain current knowledge of LCD and NCD guidelines, coding guidelines, and CMS and/or private payer guidelines
- Review and ensure government payor claims meet regulatory, federal, and state billing requirements prior to claim submission
- Receive and review correspondence regarding payor denials to ensure timely filing requirements are met
- Submit inpatient DRG validation and medical necessity appeals to payers
- Refer DRG validation and medical necessity denials to appeal vendor
- Audit Medicare Hospice prebilled medical records to ensure all claims meet medical necessity
- Receive and perform audit on all required reports
- Participate in utilization review meetings
Skills on Resume:
- Billing System Management (Hard Skills)
- Knowledge of LCD/NCD and Coding Guidelines (Hard Skills)
- Regulatory Compliance (Hard Skills)
- Denial Management (Hard Skills)
- Medical Necessity and DRG Validation (Hard Skills)
- Audit Proficiency (Hard Skills)
- Utilization Review Participation (Soft Skills)
- Attention to Detail (Soft Skills)
2. Coding Auditor, Anthem Inc., Richmond, VA
Job Summary:
- Review governmental and private payer Additional Documentation Requests (ADRs) and approve release of information for electronic submission
- Reconcile appeals process to ensure all claims and/or appeals meet regulatory, federal, and state billing requirements and are followed up with in a timely manner
- Communicate audit findings to billers, coders, physician office staff, physicians, and/or allied health professionals
- Establish and maintain positive relationships across many departments for claims audit processing
- Provide educational material to medical and allied health staff regarding changes in industry standards as it relates to claim submissions
- Facilitates problem solving and collaboration with functional area(s)
- Maintain expertise in coding by keeping current with regulatory requirements
- Maintains knowledge of Franciscan Alliance coding software tools such as CAC, encoder, EPIC, coding professional resources and PWC SMART system.
- Assists with identification and implementation of process improvements according to industry best practice standards to make best use of resources, decrease costs, and improve coding services across the corporation.
- Manage quarterly external coding audits and ensure that reports are reviewed and accurate for release to hospital and division management.
Skills on Resume:
- Regulatory Compliance and Documentation Management (Hard Skills)
- Claims and Appeals Reconciliation (Hard Skills)
- Effective Communication (Soft Skills)
- Interdepartmental Relationship Management (Soft Skills)
- Educational Outreach (Soft Skills)
- Problem Solving and Collaboration (Soft Skills)
- Coding Expertise and Software Proficiency (Hard Skills)
- Process Improvement and Audit Management (Hard Skills)
3. Coding Auditor, Kaiser Permanente, Oakland, CA
Job Summary:
- Perform quality reviews for coding staff to ensure they are meeting established quality standards
- Review quality review results in timely with coding Managers, Supervisors, Coding Educators, and coding staff
- Coordinate communication and training as a result of the findings with the Coding Educators
- Provide documentation to the coding manager for corrective action as a result of the coding review
- Ensure quarterly random internal quality review scores are tallied for performance evaluations
- Perform audits resulting from corrective action
- Review inpatient accounts flagged by coding edits software
- Analyze inpatient coding data in the coding edits system to identify aberrant coding practices that do not fall in line with established coding policies and procedures.
- Coordinate corrective action with coding managers and provide feedback to coders.
- Assist coding supervisor with reviewing and responding to external coding audits.
- Coordinate communication and training as a result of the response with the Coding Educators.
Skills on Resume:
- Quality Assurance and Review (Hard Skills)
- Data Analysis (Hard Skills)
- Communication and Coordination (Soft Skills)
- Documentation and Reporting (Hard Skills)
- Training and Education (Soft Skills)
- Audit Management (Hard Skills)
- Compliance and Policy Adherence (Hard Skills)
- Problem-Solving (Soft Skills)