A medical coding quality coordinator or auditor helps ensure the medical facility and provider receive the maximum reimbursement available for procedures performed. She uses her knowledge to review information in a patient's chart and determine whether the medical coder billed all of the services and picked the correct procedure and diagnosis codes.
Work Into Quality Coordinating
While each company has specific requirements for a coding quality coordinator, a minimum of an associate degree in a medical or related field, such as medical coding or nursing, is often preferred. Additionally, certification as a medical auditor through an accredited program, such as the American Association of Professional Coders, is often required. This ensures you have sufficient knowledge in medical coding, billing, auditing and practice management. Most companies hiring a quality coordinator also require at least two years of previous experience in medical coding. This often includes obtaining certification as a certified coding specialist from an accredited state or national program. Other experience gained as a coder includes an in-depth understanding of medical terminology, working with various basic computer programs and other medical-specific programs, and learning various coding requirements for insurance companies, like Medicare and Medicaid.
Reviewing current coding procedures to ensure they meet current standards is a responsibility of the coding coordinator. She reviews claims submitted to insurance companies and determines whether the coder applied the correct, current procedural terminology and diagnosis codes. She ensures the coder follows the guidelines set forth by the American Medical Association and Centers for Disease Control and Prevention. The coding must also meet the medical necessity requirements set by the insurance company.
Using Personal Skills
The quality coordinator posses several skills that include organization and attention to detail. He must also work well with other employees, staff members and medical providers. The coordinator, or auditor, uses his communication skills to teach the medical coder how to correct coding and billing issues and increase performance. He also possesses a positive attitude that helps motivate others in the facility.
Adding Extra Duties
As a coding quality coordinator, expect to spend a substantial amount of time meeting with upper management in person, on conference calls and through video conferencing via the Web. Since the job requires reporting findings to management, you are generally required to create reports outlining your audit findings, including the number of errors located and the amount of revenue affected by the errors. You can expect to provide your personal recommendations regarding policy changes regarding coding as well.
- American Association of Professional Coders: Medical Certification Overview
- American Medical Association: CPT -- Current Procedural Terminology
- Centers for Disease Control and Prevention: Guidelines and Recommendations
- Maxim Health Information Services: Medical Coder Auditor Jobs
- AHIMA: Certified Coding Specialist (CCS)
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