Outpatient Coding Auditor
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Job Location:
Danbury, CT - USA
Hourly Salary:
$ 25 - 47
Posted on:
29-08-2025
Vacancies:
1 Vacancy
Job Summary
Description
Must Reside inAL AZ CO CT DE FL GA IL IN KS MA MD ME MI MS NC NH NJ NY OH PA SC TN TX VA
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.
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.
Requirements:
Must have strong surgical auditing coding background in multiple specialties such as neurosurgery general surgery gastroenterology cardiothoracic surgery IR Anastomosis GI surgery and evaluation and management services.
License Registration or Certification Requirements: CPC CPC-H or CCS-P AAPC or AHIMA required
Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required
Ability to research coding and documentation criteria using the following resources
o CMS Local Coverage Determination (LCD) and Local Coverage Article (LCA)
o Federal Register and CMS Final Rule
o NGS Medicare
o Office of Inspector General (OIG) workplan
Ability to develop education materials for Coders and Providers
o Power point presentations
o Documentation and reporting tip sheets/job aides
o Public speaking skills for live education using Microsoft Office Teams
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
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
Our hospitals, medical practice and care centers are located throughout New York’s Hudson Valley and Western Connecticut. At every location, you’ll find excellent convenient care, a personalized approach, a connected team, and access to our network of doctors. Find care now.
