[Hiring] ASC Facility Coding Auditor @Pinnacle Healthcare Consulting LLC

Role Description

The ASC Facility Coding Auditor plays a critical role in ensuring the accuracy and compliance of medical coding within Ambulatory Surgery Centers (ASCs). This position is responsible for meticulously reviewing medical records and coding data to verify that all procedures and diagnoses are correctly documented and coded according to current regulatory standards and payer requirements. The auditor’s work directly impacts reimbursement accuracy, regulatory compliance, and the overall financial health of the facility. By identifying coding discrepancies and providing actionable feedback, the auditor helps reduce claim denials and supports continuous improvement in coding practices. This role requires a deep understanding of medical terminology, coding guidelines, and healthcare regulations to maintain the highest standards of coding integrity and operational efficiency.

Qualifications

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential.
• Minimum of 5 years of experience in medical coding, preferably within an Ambulatory Surgery Center or similar outpatient setting.
• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding systems and guidelines.
• Familiarity with healthcare compliance regulations including HIPAA and the False Claims Act.
• Proficiency in using electronic health records (EHR) and coding audit software.

Requirements

• Certified Coding Auditor (CCA) or Certified Inpatient Coder (CIC) certification.
• Experience with ASC billing and reimbursement processes.
• Background in healthcare quality assurance or compliance auditing.
• Advanced knowledge of payer-specific coding and billing requirements.
• Strong analytical skills with experience in data analysis and reporting tools.

Responsibilities

• Conduct detailed audits of medical records and coding data from ASC procedures to ensure accuracy and compliance with ICD-10, CPT, and HCPCS coding standards.
• Identify and document coding errors, inconsistencies, and potential compliance risks, providing clear and constructive feedback to coding staff and clinical teams.
• Collaborate with billing, compliance, and clinical departments to resolve coding discrepancies and support corrective action plans.
• Stay current with changes in coding guidelines, payer policies, and healthcare regulations to ensure audit practices reflect the latest standards.
• Prepare comprehensive audit reports and present findings to management, recommending process improvements to enhance coding accuracy and reimbursement outcomes.

Skills

The ASC Facility Coding Auditor utilizes their expertise in medical coding systems daily to meticulously review and validate procedure and diagnosis codes, ensuring compliance with regulatory and payer standards. Analytical skills are essential for identifying patterns of coding errors and potential compliance risks, enabling the auditor to provide precise feedback and recommendations. Communication skills are critical when collaborating with clinical and billing teams to clarify documentation and resolve discrepancies. Proficiency with electronic health records and auditing software facilitates efficient data retrieval and audit documentation. Additionally, staying informed about evolving coding guidelines and healthcare regulations allows the auditor to adapt processes and maintain the highest standards of coding accuracy and compliance.