CODING AUDITOR SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

Published: July 23, 2024 - The Coding Auditor with comprehensive certifications such as RHIA, RHIT, CCS, CPC, COC, or CASCC brings seasoned expertise in medical record coding and auditing, primarily in hospital settings. This role demands a meticulous understanding of various coding systems including ICD10CM, ICD10 PCS, and CPT-4, along with a firm grasp of NCCI, DRG/APC payment classifications, and Medicare regulations. The position is sedentary, based in a general office environment, and requires excellent verbal and written communication skills for effective interactions across departments during regular business hours.

Essential Hard and Soft Skills for a Standout Coding Auditor Resume
  • Medical Coding
  • Auditing Techniques
  • Compliance Knowledge
  • ICD and CPT Coding
  • Data Analysis
  • Medical Terminology
  • Health Information Systems
  • Billing Procedures
  • Electronic Health Record (EHR) Proficiency
  • Regulatory Standards.
  • Attention to Detail
  • Analytical Thinking
  • Problem-Solving
  • Communication
  • Integrity
  • Discretion
  • Adaptability
  • Organization
  • Teamwork
  • Continuous Learning.

Summary of Coding Auditor Knowledge and Qualifications on Resume

1. BS in Health Information Management with 3 years of Experience

  • Knowledge of Certified Coding Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA)
  • Knowledge of Certified Professional Coder (CPC) credentialed from the American Academy of Professional Coders (AAPC) 
  • Knowledge of Reg Health Info Admnstr credentialed from the American Health Information Management Association (AHIMA)
  • Knowledge of Reg Health Info Tech credentialed from the American Health Information Management Association (AHIMA)
  • Experience in claims processing and/or claim auditing
  • Knowledge of claim processing and coding requirements for various bill types including REVENUE, CPT, HCPCS, ICD10 processing guidelines 
  • Strong background in claim adjudication, self-funded and insured health plans, billing and coding as well as ERISA/Compliance requirements
  • Knowledge of formal Courses in ICDCM/PCS coding, CPT coding, medical terminology, anatomy & physiology, and pathophysiology (disease processes). 
  • Experience in producing transcripts of successful completion (C or higher).
  • Knowledge of A RHIA, RHIT, or CCS
  • Experience coding experience in a medically relevant setting
  • Demonstrated proficiency in PC use, Microsoft applications and working knowledge of 3M and Cerner
  • Knowledge of  certifications: CCS, RHIT/RHIA

2. BS in Medical Informatics with 6 years of Experience

  • Knowledge of RHIA, RHIT, CCS, CPC, COC or CASCC
  • Knowledge of medical record coding experience preferably in a hospital setting
  • Knowledge of medical record auditing/validation experience
  • Experience in providing high-speed internet connection and a work environment free from distractions
  • Ability to work during business hours as this position requires frequent interactions with the team and other departments within HMS
  • Primarily sedentary work in a general office environment
  • Ability to communicate and exchange information
  • Ability to comprehend and interpret documents and data
  • Experience with extensive knowledge ICD10CM, ICD10, PCS, and CPT-4
  • Experience in maintaining an understanding of the NCCI, DRG/APC payment classifications.
  • Knowledgeable about Medicare and other governmental regulations
  • Demonstrated verbal and written communication skills

3. BA in Health Administration with 2 years of Experience

  • Have completed HIMAA Clinical Coding Course (or equivalent)
  • Experience as a clinical coder including complex and varied cases
  • Extensive private hospital coding experience with an understanding of private health insurance rules and funding models
  • Understanding and knowledge of clinical coding using the current ICD-AM and the ability to apply up-to-date coding standards and practice
  • Able to work within a team environment or independently, using initiative to investigate concerns and participate in the development of audit programs
  • Have well-developed negotiation and conflict resolution skills
  • Have effective communication (written and verbal), interpersonal, planning, and organization skills
  • Ability to work in a dynamic, fast-paced environment, managing multiple tasks, delivering results within timeframes and maintaining positive relationships with all stakeholders
  • High-level computer literacy using Microsoft Office and 3M Code Finder
  • Have completed Associate Diploma or Bachelor of Applied Science, Health Information Management
  • Have completed the Certificate of Clinical Coding Auditing
  • Experience as a clinical coding auditor
  • Experience using Meditech
Relevant Information
Certified Coding Specialist Skills, Experience, and Job Requirements