Medical Auditor (Billing and Coding)

OrthoVirginia•Remote VA, VA

4d•$26 - $40•Hybrid

About The Position

Responsible for conducting coding and documentation audits for assigned providers and consulting and educating providers on documentation requirements and other compliance issues related to billing. Under the direct supervision of the Billing & Coding Compliance Manager, this full-time position will work with physicians and other clinicians to ensure they comply with documentation and coding standards, regulations and requirements. This includes conducting billing and coding audits, identifying and resolving issues, and educating clinicians and staff on requirements for documenting, coding and billing medical services.

Requirements

Previous coding experience required
Bachelor’s Degree or equivalent with 3+ years’ experience working as a credentialed coder, preferably in a medical practice
Licensing, certification/degree as one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Evaluation and Management Coder (CEMC) required
Thorough knowledge of CPT and ICD coding principles and guidelines
Knowledge of Medicare and Medicaid rules for documentation of billed services
Strong analytical and problem-solving skills required including experience auditing
Ability to exercise initiative, problem-solving and decision-making to effectively plan, prioritize, and complete projects/tasks with little supervision in a fast paced, changing environment
Specific, thorough understanding of regulatory requirements relating to documentation, claims processing, reimbursement, and coding
Skilled in establishing and maintaining effective professional working relationships with physicians, advanced practice providers, administration and team members
Advanced working experience in Microsoft Office including Excel (formulas, pivot tables, dashboards, etc)
Exceptional written and strong verbal communication skills: Meeting, presenting and corresponding with clinicians.
Has access to and knowledge of extremely sensitive, private and confidential materials-ability to maintain the highest standard of confidentiality is required with zero tolerance
Participates in professional developments efforts to ensure currency in health care policies and trends

Nice To Haves

Exemplifies OrthoVirginia’s values – excellence, compassion and unity

Responsibilities

Assists with monitoring of OrthoVirginia’s Compliance Program as related to billing, coding, and documentation, including the OIG Compliance Program guidance for physician practices and third-party billing companies
Performs audits of coding and billing data for accuracy and compliance with federal regulations
Conducts physician, APP and scribe coding and documentation education classes as needed/requested
Educate clinicians on documentation and coding requirements to ensure accurate coding level assignment and compliance, utilizing exceptional written and verbal communication skills through face-to-face interactions, email, written correspondence, and telephone communication.
Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through education, and other educational activities.
Meets with assigned providers on a regular basis to educate and review results of audits
Responsible for keeping up to date with all E/M Documentation Guidelines
Monitors all compliance issues identified during routine audits and recommends areas that indicate a focused audit may be necessary
Assists with projects as directed
Maintains detailed knowledge of practice management and other computer software as it relates to job functions