Physician Coding Auditor

Physician Coding Auditor

The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling 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.

Orlando Health is committed to providing benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you.

Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our community. So, no matter who you are, what you believe or how you express yourself, you are welcome here.

Orlando Health - Benefits & Perks: Competitive pay Evening, nights, and weekend shift differentials offered for qualifying positions. All Inclusive Benefits (start day one) Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.

Responsibilities Essential Functions:

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Review medical records to ensure coding accuracy.
• Identify and communicate physician documentation and coding opportunities for improvement.
• Provides 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.
• Collaborates with Physician Coding Education Team to ensure appropriate and complete coding accuracy for payor guideline reimbursement.
• Utilizes resource material available in department, CMS, AMA, AHCA and federal registry to support coding practices.
• Maintains 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.
• Serves as a resource to new coders.
• Addresses all Orlando Health departments professionally and positively, in all settings, by always 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.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• Attends payor, departmental and interdepartmental meetings as required.
• Other duties as assigned based on organization needs and projects.
• Works 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.
• Conducts focused physician reviews as needed and provides data to manager.

Qualifications Education/Training:

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

Licensure/Certification:

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

Experience:

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

Skills Knowledge:

• 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