HIM Audit Specialist / PB Coding

Hartford HealthCare; Farmington (CT); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote auditing of records

Competitive benefits

Work-life balance

Job summary

Hartford HealthCare in Farmington, CT is seeking an Audit Specialist to review clinical documentation and determine appropriate CPT, ICD-10 and HCPCS coding in accordance with regulatory and payer requirements.

The role focuses on timely chart audits, education support, and process improvement across the organization, with remote auditing up to necessary scope and a strong emphasis on confidentiality and accuracy in a fast-paced healthcare environment.

Qualifications

• Minimum: High School Diploma.
• Preferred: Associates Degree.
• 3 years’ work experience with CPT, HCPCS and ICD-10 coding conventions.
• Chart review of documentation of Evaluation and Management.
• Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary.
• Experience working with CMS, health insurers strongly desired.
• Experience auditing documentation.

Responsibilities

• Analyze provider documentation for appropriate assignment of EM CPT, ICD-10, and modifiers. Audit charts assigned timely and efficiently providing feedback from the audit to the educators.
• Researches literature from regulatory groups such as; HHS/OIG, Medicare, Medicaid and NGS to keep organization current with regulatory requirements and accepted audit practices.
• Communicate with team members on findings from the chart audits to help support and create training material for the providers
• Help support creating documentation templates designed for specialty/client, e.g., medical reports, monitoring/analysis reports, continuous auditing tools, etc.
• Identity’s common documentation and coding issues and process improvement and effectively communicates with team the findings.

Skills

CPT coding

HCPCS coding

ICD-10 coding

Chart review

Regulatory compliance

Analytical skills

Written communication

CMS regulations

Education

High School Diploma

Associates Degree

Tools

Epic

Healthicity

Intel Code

MS Word

MS Excel

PowerPoint

Job description

Location Detail:

9 Farm Springs Rd Farmington (10566)

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary

The Audit Specialist is responsible for reviewing clinical documentation to determine appropriate coding assignment for ICD-10, HCPC and CPT for coding consistent with regulatory, contractual, professional standards and healthcare revenue cycle industry practices.

Key Areas of Responsibility

• Analyze provider documentation for appropriate assignment of Evaluation and Management (EM) CPT, ICD-10, and modifiers. Audit charts assigned timely and efficiently providing feedback from the audit to the educators.
• Researches literature from regulatory groups such as; HHS/OIG, Medicare, Medicaid, NGS, etc., professional and peer organizations' practices/policies/guidelines to keep organization current with regulatory requirements and accepted audit practices.
• Communicate with team members on findings from the chart audits to help support and create training material for the providers
• Help support creating documentation templates designed for specialty/client, e.g., medical reports, monitoring/analysis reports, continuous auditing tools, etc. to insure appropriate documentation is captured for services rendered.
• Identity’s common documentation and coding issues and process improvement and effectively communicates with team the findings.

Working Relationships

Job Title of Individual(s) Reports To: Manager Audit and Education

Requirements and Specifications

Education

• Minimum: High School Diploma
• Preferred: Associates Degree

Experience

• Minimum:
• 3 years’ work experience with CPT, HCPCS and ICD-10 coding conventions required.
• Chart review of documentation of Evaluation and Management
• Experience with interpreting Medicare, Medicaid and third-party billing and compliance regulations necessary.
• Preferred:
• Experience working with CMS, health insurers strongly desired.
• Experience auditing documentation preferred.
• Experience with Word, Excel and PowerPoint required. Knowledge of business systems, e.g., Epic, Healthicity, Intel Code preferred

Licensure, Certification, Registration

• Minimum: CPC, CCS-P, or CCS certification required and maintained thereafter.
• Preferred: CPMA

Knowledge, Skills And Ability Requirements

• Maintain required daily productivity
• Function independently
• Collaborate with others to achieve a common goal through mutual cooperation
• Commitment to maintain complete confidentiality of patient health information
• Will require remote auditing of records
• Must be able to excel in a fast paced business environment handling multiple priorities.
• Must be highly effective in both written and oral communication
• Must be able to exercise appropriate judgment when making decisions
• Good organizational skills
• Proficiently read and interpret physician writing
• Solid analytical capabilities

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.