The Medical Record Coding Auditor reviews insurance payments and denials and recommends billing corrections. Audits medical records to ensure compliance with the organization's coding procedures and standards. Being a Medical Record Coding Auditor typically requires a bachelor's degree. Trains staff members on the coding process. In addition, Medical Record Coding Auditor typically reports to a supervisor or manager. Requires CPC (Certified Professional Coder) certification from the American Association of Professional Coders. Medical Record Coding Auditor's years of experience requirement may be unspecified. Certification and/or licensing in the position's specialty is the main requirement.
A clinical coder - also known as clinical coding officer, diagnostic coder, medical coder, nosologist or medical records technician - is a health information professional whose main duties are to analyse clinical statements and assign standard codes using a classification system. The data produced are an integral part of health information management, and are used by local and national governments, private healthcare organizations and international agencies for various purposes, including medical and health services research, epidemiological studies, health resource allocation, case mix management, public health programming, medical billing, and public education.
For example, a clinical coder may use a set of published codes on medical diagnoses and procedures, such as the International Classification of Diseases (ICD) or the Common Coding System for Healthcare Procedures (HCPCS), for reporting to the health insurance provider of the recipient of the care. The use of standard codes allows insurance providers to map equivalencies across different service providers who may use different terminologies or abbreviations in their written claims forms, and be used to justify reimbursement of fees and expenses. The codes may cover topics related to diagnoses, procedures, pharmaceuticals or topography. The medical notes may also be divided into specialities for example cardiology, gastroenterology, nephrology, neurology , pulmonology or orthopedic care.
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