Coding Auditor, Physician Group

ECU Health Medical Center•Greenville, NC

3d•$59,446 - $86,647•Hybrid

About The Position

Responsible for the creation and maintenance of audit and education programs that will ensure success for all staff and employed providers based on their specific needs and support accurate, compliant coding practices for ECU Health Physicians in accordance with coding guidelines. Conducts internal auditing of medical coding activities using concurrent, prospective and retrospective models as appropriate and/or required. Reviews electronic health information to determine accuracy of coding, billing and documentation, including validation of ICD10CM, CPT, HCPCS and modifier assignment related to medical provider professional Part B services according to regulatory and institutional policy. Reports findings, both written and verbal, to leadership as necessary to include provision of corroborating regulatory or policy guidance. Maintains documentation of all audit activities and communicates the findings with leadership. Utilizes findings to generate topics for education and training, including code assignment, process improvement, system logic, risk reduction and reimbursement optimization. Develops and coordinates education based on the specific needs of the individual or functional unit. Provides orientation and education to new provider hires. Assists coding leadership with education, training and review of coding personnel activities as needed.

Requirements

At least 5 years of multidisciplinary physician based coding or auditing experience required.
Bachelor's Degree in Health Information Management or Associates Degree in Health Information Technology or Medical Office Administration required, or higher.
RHIA, RHIT, CCS, CPC, or CCS-P certification required.
CCS, CCS-P or CPC and a minimum of 8 years of physician based coding or documentation audit experience may be substituted for the education requirement.

Responsibilities

Performs coding audits on professional fee encounters to determine accuracy of ICD10CM, CPT, HCPCS codes and modifiers selected for claim submission. Frequency of audits and volume of encounters audited will be established in accordance with organizational policy.
Documents details of audit findings in auditing software. Prepares and distributes reports of audit findings.
Provides information to leadership on the status of coding audits and all related activity.
Takes initiative to analyze, investigate and research regulatory topics for guidance to efficiently and effectively develop educational plans. Guidance includes but is not limited to CMS, NC Medicaid, AMA CPT, organization policy or other governing bodies as it relates to provider documentation and medical coding.
Assists with updating and developing Medical Group coding policies and procedures and other duties as assigned.
Develops focused educational materials, including but not limited to presentations, training classes, tip sheets, etc. based on needs as outlined and/or requested by leadership.
Provides individualized training based on audit results. Provides ongoing support and education to individuals falling below organizational assigned performance levels.
Ensures all staff and employed providers engaged in coding and billing activities are appropriately and timely updated on changes in medical coding and reimbursement laws, regulations and guidelines.
Prepares and conducts education upon request for providers, coding staff and external departments related to recognized documentation policy, medical coding guidelines, and billing requirements.
Serves as an expert resource for questions on compliant coding practices and researching regulatory topics for guidance.
Participates in education of new providers and/or coding staff.
Participates in education of students as a part of student internship experiences.
Works closely with leadership to identify trends and areas of vulnerability.
Identify areas of revenue integrity opportunities via routine audits as well as via special-request audits.