I have over five years of experience conducting medical billing and coding audits, ensuring compliance with federal and state regulations. My expertise includes reviewing claims for accuracy, identifying discrepancies, and recommending corrective actions. I am proficient in using various coding systems like ICD-10, CPT, and HCPCS, and have a strong understanding of payer policies. My audits have significantly reduced claim denials and improved revenue cycle management for my previous employers.

I stay updated by subscribing to industry newsletters, attending webinars, and participating in professional groups like the American Health Information Management Association (AHIMA). I also regularly review updates from CMS and other regulatory bodies. This continuous learning ensures my audits remain compliant and effective, adapting to new regulations and coding standards as they evolve.

During a routine audit, I discovered a recurring coding error that led to substantial overbilling. I documented the issue, analyzed its root cause, and presented my findings to the management team. Together, we implemented a training program for the coding staff to prevent future errors. This not only corrected the immediate issue but also enhanced the team's coding accuracy moving forward.

I employ a systematic approach, starting with a detailed review of documentation against billed services. I use checklists and audit software to ensure no detail is overlooked. Sampling techniques help me assess the scope of issues, and I prioritize findings based on their impact. Collaboration with clinical and billing teams is also key to understanding context and ensuring accurate assessments.

I approach disagreements professionally, presenting clear evidence to support my findings. I listen to the provider's perspective to understand any discrepancies. If necessary, I consult additional resources or seek a second opinion to ensure fairness. My goal is to resolve disputes amicably, ensuring compliance while maintaining positive relationships with providers.