Physician Billing (PB) Coding Auditor and Educator

Hackensack University Medical Center•Hasbrouck Heights, NJ

54d

About The Position

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Physician Billing (PB) Coding Auditor and Educator is responsible for auditing and educating healthcare providers on related applicable clinical documentation. This work supports coding and billing regulations that ensure appropriate reimbursement, public reporting, and various initiatives as directed by the Hackensack Meridian Health (HMH) Network.

Requirements

High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
Minimum of 5 years of Physician Coding experience in a large multi-specialty group.
Experience and thorough knowledge of ICD-10 and CPT coding.
Knowledge of data reporting requirements and proficiency in computer skills.
Extensive knowledge in data collection and physician coding reviews.
Must have advanced coding education and training with a strong foundation in E/M Coding.
Knowledge of Coding software and Google Suite: Sheets, Slides, and Docs.
Excellent oral and written communication skills.
Ability to work independently in a fast-paced environment.
Ability to interact with management personnel and the provider community.
Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); or Certified Professional Coder (CPC) Certification.
Certified Professional Medical Auditor (CPMA) at hire or must obtain within one (1) year of hire.

Nice To Haves

Associate's degree or higher.
Minimum of 2 years of physician quality improvement auditing/education experience.
Certified Risk Adjustment Coder (CRAC).

Responsibilities

Comply with established corporate and departmental policies, procedures, objectives, quality assurance methods, and safety codes. Demonstrate compliance with licensing, regulatory, and accrediting agency provisions as required.
Perform coding quality audits of all records (outpatient, inpatient, procedures, diagnostic testing) to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers and staff.
Create spreadsheets and summaries of audit findings.
Assist providers, practices, internal/external coding team(s), revenue cycle analysts (RCA), and Training Teams with coding inquiries.
Clarify complex discrepancies in documentation and coding; assure accuracy and timeliness of coding assignments to expedite the billing process and facilitate data retrieval for physician access and ongoing patient care.
Perform follow-up complex coding of medical records per internal or external audits identified as Coding discrepancies.
Meet or exceed productivity and quality standards and established department benchmarks.
Maintain annual mandatory education requirements specific to the position as mandated by HMH.
Keep abreast of coding guidelines and reimbursement reporting requirements, new technology, and procedures in accordance with the CMS and Office of Inspector General (OIG) regulations.
Bring identified concerns to the department manager and Director for resolution.
Participate in other special projects, duties and/or projects as assigned.
Adhere to HMH Organizational competencies and standards of behavior.