Outpatient Coding Auditor

Nuvance Health • Danbury, CT

77d • $25 - $47

About The Position

The position involves providing clinician practice coding, billing, and documentation auditing for professional coding at Nuvance Health. The role includes conducting routine quality assurance (QA) audits on the Professional Coding team and compiling reports on their accuracy for leadership. The candidate will make recommendations based on audit findings for educational programs for both coding personnel and clinical staff. This position requires advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, and state and federal regulations, including evaluation and management services (E&M leveling) and surgical specialties.

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: CMS Local Coverage Determination (LCD) and Local Coverage Article (LCA), Federal Register and CMS Final Rule, NGS Medicare, Office of Inspector General (OIG) workplan.
• Ability to develop education materials for Coders and Providers including PowerPoint presentations, documentation and reporting tip sheets/job aides, and public speaking skills for live education using Microsoft Office Teams.

Responsibilities

• Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.
• 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.
• QA activities including auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.
• Work closely with the Compliance department on audits, reporting, complaint coding issues etc.
• 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.
• 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.
• Attend required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s).
• Maintain and Model Nuvance Health Values.
• Demonstrates regular, reliable, and predictable attendance.
• Performs other duties as required.

What This Job Offers

• Industry: Hospitals
• Number of Employees: 5,001-10,000 employees