Professional Coding & Billing Auditor

* This role is scheduled to be hybrid schedule.*
For the right candidate within the US Eastern/Central time, remote option may be available.*

This position requires AAPC:
Certified Professional Coder (CPC) or AHIMA:
Certified Coding Specialist (CCS). Must obtain Certified in Healthcare Compliance (CHC) within 12 months of hire.

The Care New England Professional Coding and Billing Auditor provides audit support and guidance to management, providers, residents, and support staff in free-standing and facility-based practices.

Conducts assigned compliance audits for risk areas identified through the analysis of internal data and external sources.

Ensures all coding, billing, and documentation complies with federal and/or state regulations, private payor health care program requirements as well as the Care New England Compliance policies.

Responsible for auditing and implementing training programs to assist in achieving Care New England's goal of an effective compliance program.

Assists with new provider on-boarding education.

Consistently demonstrate a comprehensive, expert-level knowledge of all professional fee coding in accordance with グララな вс rule

AGRAM and regulations, CMS, AMA, CPT, ICD-10-CM, and HCPCS Level II procedure and supply codes coding guidelines.

Effectively review/audit medical records with focus on Evaluation and Management services to identify opportunities for clinical documentation improvement and potential coding opportunities to optimize reimbursement.

Correctly identify and implement education and training opportunities related to coding for physicians and non-physician providers based on results of chart reviews under the direction of Care New England Medical Group management team.

Be лег consistently available as a subject matter expert for coding guidelines, questions, and other issues from Care New England providers and staff.

Assist physician practices and provider-based departments as a coding subject matter expert when necessary.

Provide baseline coding education to newly hired physicians and non-physician providers/clinicians on a timely basis.

Effectively prioritize workload to complete job responsibilities. Display ability to adjust priorities based upon understanding of policies and procedures.

Complete job responsibilities by deadlines, according to established schedules or workflow requirements.

Evaluate areas in need of improvement and provide input in order to improve current methods, services, programs, or technology.

Meet departmental productivity 点 standards.

Assess, analyze and review information before making decisions and solving problems. Discuss findings with management on an ongoing basis.

Use proper judgement and knowledge of established practices and procedures when addressing problems or issues.

Associate degree in Business Management or Health Care Management or a minimum of 3-5 years’ experience, with a strong emphasis on evaluation and management documentation, coding, billing, and auditing, preferably for a medium to large physician practice group or health system. Multiple specialty coding experiences, including behavioral health preferred. Bachelor’s degree preferred.

A high-level knowledge of medical terminology, anatomy, and pathophysiology, along with understanding of the proper application of CPT procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes. Excellent verbal and written communication skills.

Proficient knowledge of MS Word, Excel, and PowerPoint required.

Evaluation and management coding and auditing expertise. Knowledge of billing, coding, clinical documentation regulations, and regulatory guidelines. Proficient with technology and software tools, including but not limited to Epic and Cerner systems, and auditing tools such as MDAudit.

Required: Certified Professional Coder (CPC). Certified in Healthcare Compliance (CHC) within 12 months of hire.
Preferred: Certified Professional Evaluation and Management Coder ( glitter ) or Certified Professional Medical Auditor ( CPMA )

Care New England Health System (CNE) and its…