Outpatient Coding Auditor

Northwell Health•Danbury, CT

About The Position

Provides clinician practice coding, billing, and documentation auditing for professional coding at Nuvance Health. Conducts routine quality assurance audits of the Professional Coding team and compiles accuracy reports for leadership. Makes recommendations for educational programs for coding personnel and clinical staff based on audit findings. The position requires advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations, evaluation and management (E&M) leveling, and surgical specialties.

Requirements

Certification from the AAPC or AHIMA: CPC, CPC-H, or CCS-P.
Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) certification.
Advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, and state and federal regulations.
Expertise in evaluation and management (E&M) leveling and surgical specialties.

Responsibilities

Conduct high-volume internal audits of physician practice medical records for documentation and coding accuracy.
Provide education to Nuvance coders and physician practices based on audit findings and as needed to reinforce proper documentation and coding consistent with Nuvance Health policies and state and federal regulatory and reimbursement guidelines.
Maintain compliance while optimizing appropriate revenue opportunities.
Conduct quality assurance audits of surgical coding levels of service performed by the Outpatient Coding team.
Work with the Compliance department on audits, reporting, and coding complaints or issues.
Research CMS and NGS Medicare regulations, guidelines, bulletins, and publications for their impact on professional services.
Monitor CMS, Medicare, NGS, AAPC, third-party payer, and professional peer organization coding and billing guidance, regulations, policies, and practices to help keep physician practices current.
Stay current with the OIG Work Plan.
Collaborate with the Outpatient Coder team to identify coding and documentation errors, patterns, trends, and variations.
Recommend improvements to coding and documentation practices to a Supervisor, Manager, or Director.
Attend required educational sessions, including webinars and conferences, to maintain and enhance coding certifications.
Maintain and model Nuvance Health values.
Demonstrate regular, reliable, and predictable attendance.
Perform other duties as required.