About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Roles and Responsibilities:

 Auditing and reviewing medical documentation for appropriate ICD and CPT coding
and ensuring that codes tally with doctors’ diagnosis.
 Asking explanation from physicians when code assignments are not straightforward or
documentation in the record is inadequate, ambiguous, or unclear for coding purposes
 Ensuring compliance with medical coding policies and guidelines.
 Be updated about new coding rules as codes change from time to time.
 Collecting and distributing coding related information and billing issues.
 Exceptional Knowledge of medical terminology, anatomy, physiology, disease
processes, and pharmacology.
 Work as part of a team and achieve the team quality and productivity standards.

Required Expertise & Qualification:

 Life Science graduation or any equivalent graduation with Anatomy/Physiology as
main subjects
 3 to 5 years of work experience as a medical coder.
 Any one of the following coding certifications CPC, COC, CRC, CPCP from AAPC CCS,
CCSP, CCA from AHIMA
 Proficient computer skills.
 Excellent communication skills, both verbal and written.
 Strong people skills & Outstanding organizational skills.
 Ability to maintain the confidentiality of information.

General Surgery Auditor

Job Title: Quality Auditor – General Surgery (Medical Coding)

Experience Required: 4–7 years in Medical Coding (with at least 1–2 years in Auditing)

1. Job Purpose

The General Surgery Auditor will perform retrospective or concurrent audits on surgical charts to ensure that CPT, ICD-10-CM, and HCPCS codes assigned by the coding team are accurate, supported by medical documentation, and compliant with CMS, NCCI edits, and payer-specific guidelines.

2. Key Responsibilities

Audit & Compliance:

• Review complex operative reports for General Surgery (e.g., Appendectomy, Cholecystectomy, Hernia repairs, Mastectomies, Thyroidectomies, Endoscopies, and Colonoscopies).
• Validate the selection of the primary procedure and any additional procedures.
• Ensure accurate application of surgical modifiers (e.g., -51, -59, -58, -78, -79, -25).
• Verify that ICD-10-CM codes support medical necessity as per LCD/NCD guidelines.
• Identify "Unbundling" practices and ensure compliance with NCCI (National Correct Coding Initiative) edits.

Feedback & Training:

• Provide detailed feedback to coders on errors identified during audits.
• Conduct "Root Cause Analysis" (RCA) for recurring errors and suggest process improvements.
• Organize weekly or monthly training sessions to update the team on CPT code changes and payer policy updates.

Reporting:

• Maintain an Accuracy Rate (Quality Score) of 95% or higher for the assigned span.
• Prepare daily/weekly audit reports (Error logs, Accuracy trackers) using MS Excel.
• Analyze denial patterns related to surgical coding and provide solutions to reduce the "Technical Denial" rate.

3. Technical Skills & Specialty Knowledge

• Surgical Nuances: Deep understanding of the Global Surgical Package (pre-op, intra-op, and post-op components).
• Anatomy & Physiology: High proficiency in human anatomy, specifically the digestive system, endocrine system, and integumentary system.
• Reference Tools: Expertise in using coding software like 3M Encoder, Optum, or EncoderPro.
• EMR/EHR: Familiarity with platforms like Epic, Cerner, or NextGen.

4. Qualifications & Experience

Education:

• Graduate/Post-graduate in Life Sciences (B.Pharm, M.Pharm, BPT, Nursing, B.Sc. Biology, or Microbiology).

Certifications (Mandatory):

• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist).
• CPMA (Certified Professional Medical Auditor) is highly preferred for this role.
• CASCC (Certified Ambulatory Surgical Center Coder) is an added advantage for surgery specialists.

Experience:

• Proven track record in General Surgery coding.
• Strong knowledge of US Healthcare reimbursement rules.

5. Key Performance Indicators (KPIs)

• Audit Volume: Meeting the daily target of audited charts (varies by company, usually 25–40 surgical charts/day).
• Quality Percentage: Maintaining a departmental quality score of >95%.
• Turnaround Time (TAT): Ensuring audits are completed within 24–48 hours of the coding date.
• Denial Reduction: Demonstrable decrease in coding-related denials over time.

6. Soft Skills

• Attention to Detail: Ability to spot minor documentation gaps that could lead to a denial.
• Communication: Ability to explain complex coding rules to coders and stakeholders clearly.
• Analytical Thinking: Evaluating the "Why" behind a surgical procedure to ensure medical necessity.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.