Outpatient Coding Auditor
Outpatient Coding Auditor
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Job Description
Description
Summary:
Purpose:Provides clinician practice coding billing and documentation auditing for professional coding at Nuvance Health. Conducts routine quality assurance (QA) audits on Professional Coding team and compiles reports on their accuracy for leadership. Makes recommendations based on audit findings for educational programs for both coding personnel and clinical staff.Requires advanced expertise in medical terminology anatomy physiology documentation coding guidelines state and federal regulations. This includes evaluation and management services (E&M leveling) and surgical specialties.
Responsibilities:
Essential Responsibilities
high volume internal audits of physician practice medical records for documentation and coding accuracy.
education sessions for Nuvance coders and physician practices based on the audit findings and as needed to reinforce proper documentation and coding consistent with Nuvance Health policies State and Federal regulatory and reimbursement guidelines maintains compliance while optimizing appropriate revenue opportunities
activities including auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.
closely with the Compliance department on audits reporting complaint coding issues etc.
CMS and NGS Medicare regulations guidelines bulletins and other publications for impact to professional listservs such as CMS Medicare NGS AAPC etc. and third-party payers for coding and billing guidelines and regulations professional peer organizations practices/policies/guidelines to help keep Nuvance physician practices current with coding and regulatory requirements and accepted compliance practices. Stay current with OIG Work Plan.
with Outpatient Coder team to identify errors patterns trends and variations in coding or documentation. Provides recommendations to Supervisor Manager or Director to improve coding and documentation practices.
required educational sessions (webinars conferences etc.) to maintain and enhance coding certification(s)
and Model Nuvance Health Values
regular reliable and predictable attendance.
other duties as required.
Other Information:
Looking for a strong surgical auditing coding background in multiple specialties (e.g. general surgery cardiovascular gastroenterology etc.) and also evaluation and management services.
License Registration or Certification Requirements:
CPC CPC-H or CCS-P required
Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required
Working Conditions:
Manual: Some manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment: Generally pleasant working conditions
Company: Western CT Health Network Inc
Org Unit: 1853
Department: CODERS - PROFESSIONAL & FACILITY CHARGING and CODING
Exempt: No
Salary Range: $25.70 - $47.72 Hourly
Employment Type
Full Time
