Medical auditor vs medical coder

Differences between medical auditor and medical coder duties and responsibilities

Medical auditor example responsibilities.

• Review confidential and substantial health documentation and make sound, evidence-base decisions concerning compliance to HIPPA and other manage care policies.
• Handle and interpret medical documentation such as UB04 claim forms and EOB's on a daily basis.
• Review all EOB's to ensure claim paid per contract and submit appeals for claims underpay or deny payment in error.
• Review medical records to determine if clinical documentation support coding and DRG assignments.
• Advance knowledge - CMS and provider contract rules.
• Process HCFA and UB claims in a production environment.
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Medical coder example responsibilities.

• Manage all EDI relate communication with trading partners and assist to produce all operational documents for all end users.
• Manage all aspects of AR including writing letters for medical necessity, claim denials, bundling issues and charge capture.
• Manage health records while applying ICD-10 coding to update and process insurance claims for time and accuracy to various insurance companies.
• Manage the outsourced transcription company.
• Create documentation education classes to general surgery residents, increasing the leveling of reporting which lead to increase revenues.
• Adhere to regulations with CPT-4, ICD-9-CM and HCPCS coding with medical terminology and effort meet all audit requirements.
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