Physician Coding Auditor

Overview

Department
:
Patient Accounting
- Physicians

Status
:
Full Time

Shift
:
Remote

Location
:
Orlando, FL

Title
:
Physician Coding Auditor

Summary
:
The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the governing compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for surgical, procedural and E/M based coding.

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor the audit results closely to identify any potential coding inaccuracy.
• Provide the Educators the needed support in identifying coding errors.
• Provide results or trends with Education Team for physician education.
• Review medical records to ensure coding accuracy.
• Identify and communicate physician documentation and coding opportunities for improvement.
• Provide feedback to physicians, non-physician providers, physician office staff, administration, practice managers, and team members of the Physician and Professional Services Central Business Office regarding best practices to ensure physician coding compliance.
• Collaborate with Physician Coding Education Team to ensure appropriate and complete coding accuracy for payor guideline reimbursement.
• Utilize resource material available in department, CMS, AMA, AHCA and federal registry to support coding practices.
• Maintain patient and coder confidentiality audit results.
• Collaborate with physician coding leadership for monitoring coding quality.
• Participate in Health Plan Audits.
• Follow and adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Perform physician queries for coding and documentation clarification during concurrent chart review process.
• Serve as a resource to new coders.
• Address all Orlando Health departments professionally and positively, maintaining a high level of professional demeanor and dress.
• Proficiency in coding including ICD-10, CPT, E/M, modifiers while maintaining a 90% accuracy.
• Adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Maintain reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintain compliance with all Orlando Health policies and procedures.

• Attend payor, departmental and interdepartmental meetings as required.
• Other duties as assigned based on organization needs and projects.
• Work in collaboration for testing, training, and mentoring incoming coders according to the coding guidelines and individual skills for the Division for which the coder will be assigned.
• Conduct focused physician reviews as needed and provide data to manager.

• High School diploma or equivalent
• Exceptional knowledge in Microsoft Office Suite
• Thorough knowledge of official coding guidelines as per AMA, AHCA, and CMS evidenced by results of coding skills test of 90% or better.

• Must maintain one (1) of the following nationally recognized certifications:
  • CPMA certification required through the American Academy of Professional Coders
  • Five (5+) years auditing experience in lieu of CPMA with expectation to acquire CPMA within 1 year of hire
  • Coding Credential
    
    Required:
    
    AHIMA or AAPC credential
  • CEMA certification via National Alliance of Medical Auditing Specialists

• Five (5+) years of professional based coding experience in multiple specialties is required.

• Strong research, organizational, multi-tasking, planning, problem-solving and critical thinking skills
• Excellent collaboration, verbal, and written communication skills with providers, leadership, and team members
• Excellent knowledge of medical terminology, CPT, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and third-party payer requirements pertaining to billing, coding, and documentation
• Expert Coding (CPT and ICD-10-CM) and auditing
• Experience working with Electronic Medical Records, EPIC experience preferred
• Excellent communication (written and oral) and interpersonal skills
• Strong organizational, multi-tasking, and time-management skills
• Must be detail oriented and able to follow through on issues to resolution
• Must be able to act both independently and as a team member
• Ability to work independently