Professional Documentation Improvement Auditor

The Professional Documentation Improvement Auditor specializes in reviewing and analyzing medical records, claims and workflow processes to ensure accuracy, completeness, and compliance with regulatory requirements. The primary goal is to improve the quality of clinical documentation, which plays a crucial role in patient care, compliance, billing, coding, and reimbursement processes.

• →Using audit tools, authoritative references, CMS and CPT guidelines, bell curves, etc. to analyze for trends, audit providers and coders, and provide education/feedback individually or in a group setting.
• →Adhering to policies, procedures and regulations to ensure compliance.
• →Audits provider services using auditing tools such as EncoderPro and MD Audit.
• →Adheres to provider auditing schedules and audit production standards set by Physician Compliance and Audit Services Director or the Physician Audit Managers.
• →Maintains provider scoring results.
• →Provides standard documentation on education feedback to providers in a timely manner. 

Job Requirements:

• Associate’s Degree
  • Additional years of experience may substitute for the required education on a year-for-year basis
• 3+ years auditing experience or 5 years of coding E&M levels of service (multi-specialty, including office visits, preventive services, surgical procedures and hospital inpatient and observation services.
• CPC (Certified Professional Coder) or equivalent certification
• Revenue Cycle experience, preferred.
• Auditing certification (e.g. CPMA-Certified Professional Medical Auditor), strongly preferred.
• Additional specialty specific certifications (e.g. CCC – Certified Cardiology Coder, COBGC – Certified OB/GYN Coder), strongly preferred
• E&M /Procedure/Surgery Auditing/Critical Care/Specialty Specific/Skewed Productivity Curves
• Application and validation of ICD-10 diagnosis codes based on coding guidelines

Preferred Job Requirements:

• Revenue Cycle experience     Additional specialty specific certifications (e.g. CCC – Certified Cardiology Coder, COBGC – Certified OB/GYN Coder)
• Auditing certification (e.g. CPMA-Certified Professional Medical Auditor)