Outpatient Coding Auditor

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 recommendations based on audit findings for educational programs for both coding personnel and clinical staff.ï½Requires 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 current with OIG Work Plan.

with Outpatient Coder team to identify errors patterns trends and variations in coding or 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.

Education Skills Experience:

License Registration or Certification Requirements:

Certification from the America Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA):

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: Nuvance Health

Org Unit: 2069

Department: CODERS - PROFESSIONAL & FACILITY CHARGING and CODING

Exempt: No

Salary Range: $26.48 - $50.49 Hourly