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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coding accuracy and compliance, with a strong focus on ICD-10-CM, HCPCS/CPT, and Medicare guidelines. Proven ability to mentor teams, conduct quality audits, and implement process improvements while maintaining high standards of productivity and accuracy.
Highest-signal resume keywords
CCS CertificationICD-10-CM ExpertiseCoding Audit ExperienceQuality Assurance ManagementMicrosoft Excel Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Coding Accuracy ReviewRoot Cause AnalysisComplex Outpatient CodingAudit ReportingMedical Record ReviewCoding DocumentationTrend AnalysisCompliance ReviewInterventional Radiology CodingSurgical Procedure Review
Soft Skills
Excellent Communication SkillsStrong Organizational SkillsAttention to DetailDecision-Making SkillsFlexibility and Adaptability
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointMicrosoft OutlookMicrosoft Word
Certifications & Qualifications
CCSCPCCOCCPMACOSCCCCCASCC
Industry Keywords
CMS GuidelinesPayer ComplianceNCCI EditsOPPS/APCMedicare LCDsNCDsCoding StandardsQuality ManagementAudit ProcessesHealthcare Compliance
About the role
Key responsibilities & impact- Review coding auditors’ work for accuracy and consistency
- Validate audit determinations, supporting documentation, and rationales against client and program expectations
- Review medical records to determine facility coding accuracy
- Assign root cause analysis categories and flag recurring trends to the Quality Manager
- Mentor coding auditors and provide feedback
- Perform quality reviews for initial audits and appeals
- Manage QA inventory and meet quality, productivity, and turnaround expectations
- Identify overpayment and underpayment findings and support audit reporting and trend analysis
- Participate in calibration sessions for consistent review decisions and coding guidance application
- Recommend process improvements
- Escalate recurring errors, guideline questions, and process gaps to the Quality Manager
- Stay current on CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM updates
- Perform other assigned duties
- Follow company compliance, information security, and regulatory policies
Requirements
What you’ll need- Bachelor’s Degree
- CCS, CPC, or COC certification required
- CPMA, COSC, CCC, or CASCC certification preferred
- Minimum 5 years coding experience
- Professional or hospital coding experience
- Thorough understanding of ICD-10-CM, HCPCS/CPT, OPPS, and APC
- Ability to code complex outpatient services, including interventional radiology, ambulatory surgery, emergency room, and observation
- Expertise in Medicare LCDs and NCDs
- Expertise in NCCI edits, MUEs, and facility modifiers such as 59/XS, 73/74, and 25
- Ability to write professional notes citing recognized coding and Medicare resources
- Prior coding audit, compliance review, RAC, or payer-side Payment Integrity audit experience preferred
- Experience reviewing operative reports for complex surgical procedures preferred
- Excellent verbal, written, and interpersonal communication skills
- Strong organizational skills, attention to detail, and accuracy
- Ability to work independently and in a team environment
- Flexibility and adaptability
- Superior coding audit and monitoring skills
- Excellent decision-making and sound judgment
- Strong technical knowledge and ability to learn new systems quickly
- Ability to complete tasks efficiently, resolve problems, and meet deadlines
- Proficiency in Microsoft Excel, PowerPoint, Outlook, and Word
Benefits
Comp & perks- Exciting, fast-paced, and innovative work environment
- Opportunity to work closely with experienced healthcare consultants
- Exposure to multiple aspects of clients’ businesses
- Teamwork and time-management skill development
- Mentoring program with a senior-level professional advisor for junior-level employees
- Career growth and development opportunities