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 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 

1.Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.

2.Conducts 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

3.QA activities including auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.

4.Work closely with the Compliance department on audits, reporting, complaint coding issues etc.

5.Research CMS and NGS Medicare regulations, guidelines, bulletins, and other publications for impact to professional services.Monitor 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.

6.Collaborate 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.

7.Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s)

8.Maintain and Model Nuvance Health Values

9.Demonstrates regular, reliable, and predictable attendance.

10.Performs 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