Evaluation and Management Auditor

adventhealth; Orlando (FL); On-site; USD 33,062 - 60,614; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

403(b) Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth Altamonte Springs seeks a qualified Medical Coder/Auditor to interpret and review medical record documentation, ensuring accurate ICD-10, CPT, HCPCS codes and modifiers in line with CMS guidelines.

Responsibilities include auditing records, educating providers and staff on documentation needs, and applying current coding regulations. Requires CPC/ CCS/ CCS-P / CPMA / RHIA/RHIT certifications and extensive auditing experience.

Qualifications

• Expert knowledge of ICD-10, CPT, HCPCS and modifiers for out/inpatient coding.
• Auditing using 1995/1997 and 2021 E/M CMS Guidelines.
• Knowledge of NCCI, MU, MUE edits and bundling.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office Suite.
• Ability to operate PCs, web tools, and teleconferencing.
• Ability to educate providers on documentation and audits.

Responsibilities

• Interprets and reviews medical record documentation for accurate coding.
• Audits medical records to ensure CMS guideline compliance.
• Educates providers, practice staff, and coders on audit findings and updates.
• Applies current coding and billing regulations in decision making.

Skills

ICD-10/CPT/HCPCS knowledge

E/M CMS Guidelines

NCCI/MUE rules

Effective communication

Microsoft Office

EMR proficiency

Auditing

Physician coding

Education

Associate degree

High School Diploma

Technical/Vocational Training

Tools

EMR systems

Job description

Our promise to you

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule

Full time

Shift

Day (United States of America)

Address

900 HOPE WAY

City

ALTAMONTE SPRINGS

State

Florida

Postal Code

32714

Job Description

Interprets and reviews medical record documentation to ensure accurate ICD-10, CPT, HCPCS, and modifiers are assigned based on provider documentation. Audits medical records using the 1995, 1997, and 2021 E/M CMS Guidelines to ensure compliance and accuracy. Provides education to providers, practice staff, and coders based on audit results, coding updates, and documentation needs. Applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.

Knowledge, Skills, and Abilities

• Expert knowledge of ICD-10, CPT, HCPCS, and coding, along with modifiers for outpatient and inpatient procedures. [Required]
• Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines [Required]
• Extensive knowledge of NCCI, MU, MUE edits and bundling guidelines. [Required]
• Demonstrates excellent written and verbal communication skills. [Required]
• Knowledgeable with Microsoft Office software. [Required]
• Ability to effectively operate equipment such as PC, web and/or teleconference. [Required]
• Ability to educate providers and staff on required documentation needs, coding updates and audit findings. [Required]
• Expert knowledge of Evaluation & Management (E&M) rules and surgical coding. [Preferred]
• Ability to explain required documentation needs to physicians, staff, and coding staff via EMR system. [Preferred]
• Experience presenting to large groups of peers or physicians/providers and leadership. [Preferred]

Education

• Associate [Preferred]
• High School Grad or Equiv [Required]
• Technical/Vocational School [Preferred]

Field of Study

• Technical school certification in medical coding preferred
• Associate degree in Medical Billing/Coding preferred

Work Experience

• 3+ certified auditing [Required]
• 5+ physician-based coding for both e&m (outpatient/inpatient) and surgical procedures [Required]

Additional Information

• N/A

Licenses and Certifications

• Certified Professional Coder (CPC) [Required]
• Certified Coding Specialist (CCS) [Required]
• Certified Coding Specialist – Physician-based (CCS-P) [Required]
• Certified Professional Medical Auditor (CPMA) [Required]
• Registered Health Information Administrator (RHIA) [Required]
• Registered Health Information Technician (RHIT) [Required]

Physical Requirements

Physical Requirements - https://tinyurl.com/23km2677

Pay Range

$23.91 - $44.46

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at https://info.flclearinghouse.com/

Equal Opportunity Employer

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.