Medical Auditor (Billing and Coding)

OrthoVirginia; United States; Hybrid; USD 36,000 - 55,000; Full time

Job summary

OrthoVirginia is seeking a Medical Auditor (Billing & Coding) to audit billing, coding, and documentation across providers. The role supports the Billing & Coding Compliance Manager and requires collaboration with physicians and clinicians to ensure compliant documentation and coding.

The position is full-time in a hybrid setting, with travel to regional offices as needed. Strong CPT/ICD knowledge, analytical skills, and communication abilities are essential.

Qualifications

• Bachelor’s Degree or equivalent with 3+ years’ experience working as a credentialed coder, preferably in a medical practice.
• Licensing/certification/degree as RHIA/RHIT/CCS-P/CPC/CEMC required.
• Thorough knowledge of CPT and ICD coding principles and guidelines.

Responsibilities

• Assist with monitoring of OrthoVirginia’s Compliance Program related to billing, coding, and documentation.
• Perform audits of coding and billing data for accuracy and compliance with federal regulations.
• Conduct education classes for physicians, APPs, and staff on documentation and coding requirements.

Skills

Analytical thinking

Communication skills

Problem-solving

Attention to detail

Education

Bachelor's Degree or equivalent

RHIA/RHIT/CCS-P/CPC/CEMC certification

Tools

Microsoft Excel

Pivot tables

Job description

At OrthoVirginia, you’re part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia’s largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment.

With more than 159 physicians in over 35 locations—including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads—OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive.

Join us and become part of a trusted network committed to excellence in orthopedic care.

Medical Auditor (Billing & Coding)

Previous coding experience required
Hybrid - must be able to travel by car to regional offices

Job Description

Responsible for conducting coding and documentation audits for assigned providers and consulting and educating providers on documentation requirements and other compliance issues related to billing.

Under the direct supervision of the Billing & Coding Compliance Manager, this full-time position will work with physicians and other clinicians to ensure theycomplywithdocumentation and coding standards,regulationsand requirements. This includes conducting billing and coding audits,identifyingand resolving issues, and educating clinicians and staff on requirements for documenting,codingand billing medical services.

Job Responsibilities and Accountabilities:

• Assistswith monitoring of OrthoVirginia’s Compliance Program as related to billing, coding, and documentation, including the OIG Compliance Program guidance for physician practices and third-party billing companies
• Performs audits of coding and billing data for accuracy and compliance with federal regulations
• Conducts physician, APP and scribe coding and documentation education classes as needed/requested
• Educate clinicians on documentation and coding requirements to ensureaccuratecoding level assignment and compliance,utilizingexceptional written and verbal communication skills throughface-to-faceinteractions, email, written correspondence, and telephone communication.
• Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through education, and other educational activities.
• Meets with assigned providers on a regular basis to educate and review results of audits
• Responsible for keeping up to date with all E/M Documentation Guidelines
• Monitors all compliance issuesidentifiedduring routine audits andrecommendsareas thatindicatea focused audit may be necessary
• Assistswith projects as directed

Qualified Candidates must meet all of the following criteria:

• Exemplifies OrthoVirginia’s values – excellence,compassionand unity
• Bachelor’s Degree or equivalent with3+years’ experience working as a credentialed coder, preferably ina medicalpractice
• Licensing, certification/degree as one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Evaluation and Management Coder (CEMC)required
• Thorough knowledge of CPT and ICD coding principles and guidelines
• Knowledge of Medicare and Medicaid rules for documentation of billed services
• Strong analytical and problem-solving skills required including experience auditing
• Ability to exercise initiative,problem-solvingand decision-making to effectively plan, prioritize, and complete projects/tasks with little supervision in a fast paced, changing environment
• Specific, thorough understanding of regulatory requirements relating to documentation, claims processing, reimbursement, and coding
• Skilled inestablishingand maintaining effective professional working relationships with physicians, advanced practice providers,administrationand team members
• Advanced working experience in Microsoft Office including Excel (formulas, pivot tables, dashboards,etc)
• Exceptional written and strong verbal communication skills:Meeting,presentingand correspondingwith clinicians.

Other:

• Hasaccess to and knowledge of extremely sensitive,privateand confidential materials-ability tomaintainthe highest standard of confidentiality isrequiredwith zero tolerance
• Participates in professional developments efforts to ensure currency in health care policies and trends
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Some travel to regional offices will berequired

Compensation Range for this position:

$26.44 - $39.66

Compensation for this role will be based on several factors, including the candidate’s qualifications, relevant experience, education, skills, certifications, geography/market, and internal equity considerations.

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