Regulatory Services Coding Auditor

Physicians East•Greenville, NC

30d•Hybrid

About The Position

We are looking for an employee that can work in a fast-paced office setting to conduct in-house audits, provider education, and provide coding related support to expedite the billing process. Additionally, proactively appeals, and assists with rebilling of claims addressing identified errors. Predominantly remote position with periodic travel to Physician's East locations to deliver audit findings and conduct provider education. A period of training will be required on site. Applicant must be located in North Carolina. Supervision Received: Reports to Regulatory Services Manager. Supervision Exercised: Limited. Typical Physical Demands: Requires prolonged standing or sitting while working in an work environment. Requires some bending or stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment. Typical Working Conditions: Hybrid - Onsite and Remote with 30% travel

Requirements

Associate degree or bachelor's degree in health information management with RHIT/RHIA certification and 3-5 years of multi-specialty ICD-10 and CPT experience, or bachelor's degree in health care related field with CPC/CCS-P/CPMA certification and 2-4 years of direct ICD-10 and CPT experience, or CPC/CCS-P/CPMA certification with 4-6 years of multi-specialty ICD-10 and CPT experience.
Applicant must be located in North Carolina

Responsibilities

Reviews patients' medical records to ensure coding levels and charting meets standards and regulations
Capable of performing retro audits on patients' account to ensure documentation supported the level of Evaluation and Management charged
Completes analysis, charts, and spreadsheets to present outcomes to management and physicians
Educates physicians and employees on compliance audit findings by specialty after routine audits or when problems are identified
Responsible for being up-to-date and knowledgeable of coding process and diagnostic procedures as well as carrier specific policies, guidelines, and updates
Research contract allowable to ensure proper payment as well as remaining current about federal and state legislative changes that affect outcomes
Share information as necessary with the Coding & Insurance departments
Stay informed of updates on payer websites
Communicate with Coding and Insurance Supervisors regarding denial trends, problematic denials, and reimbursement issues
Inform Regulatory Services Manager of CPT codes that are routinely not paid, repetitive noncovered diagnoses, or codes not paying according to contractual fee schedules
Reports all identified compliance audit issues to Regulatory Services Manager
Assist Coding and Insurance departments with third party payer coding rules and regulation questions
Provide coding related support to the Coding and Insurance departments for follow-up to expedite appeals and rebilling of claims. This will include researching and correcting claims to validate denial adjustments
Communicates closely with the Insurance Department Medicare Team to ensure that secondary claims are not held up due to coding issues
Provide other assistance to the Coding or Insurance Department as directed by the Regulatory Services Manager
Maintains patient confidentiality
Ability to work independently and proficiently in a remote office environment
Attends meetings when required (onsite/remote)