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Position Classification Description

Position Class Code / Title: B4001 / Med Coding Auditor
Recruitment Tier: Tier 1
FLSA: Non-Exempt
Grade: 12

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Under indirect supervision, audits medical charts and records for compliance with federal coding regulations and guidelines. Uses knowledge of UNM/UPA and client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. Reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with UNM/UPA billing requiremnts and compliance standards.

Duties and Responsibilities

  1. Audits medical record documentation to identify undercoded and upcoded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
  2. Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  3. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
  4. Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
  5. Trains, instructs, and/or provides technical support to medical providers and Medical Coding Analysts as appropriate regarding coding complaince documentation, and regulatory provisions, and third party payer requirements.
  6. Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and data management systems to coordinate these with UNM methodology, to ensure that client billing operations meet the joint requirements of both the local facility and UPA.
  7. Interacts with providers and management to review and/or implement codes and to update charge documents.
  8. Ensures strict confidentiality of financial records.
  9. Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
  10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Technical certificate in Medical Coding or related field; at least 3 years of experience directly related to the duties and responsibilities specified.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Knowledge of auditing concepts and principles.
  • Advanced knowledge of medical coding and billing systems and regulatory requirements.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to analyze and solve problems.
  • Strong communication and interpersonal skills.
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
  • Knowledge of current and devleloping issues and trends in medical coding procedures requirements.
  • Ability to clearly communicate medical information to professional practitioners and/or the general public.
  • Detailed knowledge of medical coding systems, procedures, and documentation requirements.
  • Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
  • Ability to provide guidance and training to professional and technical staff in area of expertise.

Working Conditions and Physical Effort

  • No or very limited physical effort required.
  • No or very limited exposure to physical risk.
  • Work is normally performed in a typical interior/office work environment.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: 03/20/2017