Outpatient Coding Auditor

Nuvance Health Coding Position

Position at Northwell Health

Must reside in the following states: AZ, CT, DE, FL, GA, IL, IN, KS, MA, MD, ME, MI, MS, NC, NH, NJ, NY, OH, OK, PA, SC, TN, TX, and VA

Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State's largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better.

Summary

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

Responsibilities

Essential Responsibilities

• Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.
• Conducts education sessions for Nuvance coders and physician practices based on the audit findings and as needed to reinforce proper documentation and coding consistent with Nuvance Health policies, State and Federal regulatory and reimbursement guidelines, maintains compliance while optimizing appropriate revenue opportunities
• QA activities including auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.
• Work closely with the Compliance department on audits, reporting, complaint coding issues etc.
• Research CMS and NGS Medicare regulations, guidelines, bulletins, and other publications for impact to professional services. Monitor listservs such as CMS, Medicare, NGS, AAPC etc. and third-party payers for coding and billing guidelines and regulations, professional peer organizations' practices/policies/guidelines to help keep Nuvance physician practices current with coding and regulatory requirements and accepted compliance practices. Stay current with OIG Work Plan.
• Collaborate with Outpatient Coder team to identify errors, patterns, trends and variations in coding or documentation. Provides recommendations to Supervisor, Manager or Director to improve coding and documentation practices.
• Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s)
• Maintain and Model Nuvance Health Values
• Demonstrates regular, reliable, and predictable attendance.
• Performs other duties as required.

Education Skills Experience

License, Registration, or Certification Requirements:

• Certification from the America Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA): CPC, CPC-H, or CCS-P required
• Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required

Working Conditions

Manual: Some manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 2069

Department: CODERS - PROFESSIONAL & FACILITY CHARGING AND CODING

Exempt: No

Salary Range: $26.48 - $50.49 Hourly