Clinical Coding & Compliance Auditor

at MaineHealth in Scarborough, Maine, United States

Job Description

Summary

This Position is 100% Remote
Position Summary
Under the general direction of the Coding Director, this position is responsible for the accurate assignment of ICD-10-CM and CPT-4 coding of diagnoses and procedures for outpatient medical records in multiple different outpatient settings including Outpatient Hospital Clinics, ASU, OBSV, interventional radiology/cardiac cath/angiography records, Provider Based Clinics (inclusive of E/M, Coding for both inpatient and outpatient professional procedures), IV therapy, Emergency department and other areas as needed. Position includes performing auditing to determine accuracy and completeness of the outpatient record, utilizing the 3M Coding Reimbursement and Epic EMR systems to compile data. The Clinical Coding Auditor evaluates medical necessity and Correct Coding Initiative edits and resolves them accurately. Data reported is used to meet licensure requirements, statistical purposes and reimbursement purposes.

Required Minimum Knowledge, Skills, and Abilities (KSAs)
Education: Associates degree in science field strongly preferred with completion of an accredited program through AHIMA or AAPC. Credential of CPC, CCS, or CPMA preferred Preferred 4 years of experience with Project Coordination skills Experience of physician & hospital practices EPIC experience preferred; Time Management and Organizational skills: Ability to multi task and maintain positive attitude in high stress environments Computer proficiency including MS Office, other web-based applications, EMRs, other coding software.
License/Certifications: RHIT, RHIA, CCS, CCA, CPC, CPC-H, or CIRCC credential preferred.
Experience: Minimum of two (2) years of multi-specialty, preferably surgical coding experience, with CPT/ICD-10-CM/HCPCS/modifier coding for physician professional charges and a minimum of two (2) years' experience in an acute care facility as a ASU Clinical Coder. Required experience coding E/M's, Outpatient Hospital Clinics, OBV, ASU, Professional Surgical CPT's, ED's, cardiac cath/angiography, and simple visit coding.
Proficiencies: Demonstrated knowledge of ICD-10-CM, CPT-4 and HCPCS coding guidelines and principles required. Employee has the ability to demonstrate competence and knowledge-base through the utilization of a standardized test with a minimum of 95% accuracy while meeting productivity requirements.
Specialized Knowledge: Strong ability to apply broad guidelines to specific coding situations, independently, utilizing discretion and a significant level of analytical ability.
Additional Information

MaineHealth was ranked one of America's Best Large Employers in 2022 by Forbes!

MaineHealth is a not-for-profit integrated health system whose vision is, "Working together so our communities are the healthiest in America." MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. With approximately 22,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. Learn more about our system at

At MaineHealth, we offer benefits that support an individual's needs for today and flexibility to plan for tomorrow. Our packages include health and dental insurances, paid parental leave, retirement program, generous paid time off, and much more! Our comprehensive array of benefits are competitive, affordable, and include choices that meet specific, but ever changing, needs.

With a career at any of the MaineHealth locations, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the well-being of our communities and care team members. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Join us, and your abilities will be challenged and enhanced as you take your career to a new level.
Additional Information  MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org

MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.