Nurse Practitioner, Coding Auditor

Personalized Health Partners; Blue Ash (OH); Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a dedicated Nurse Practitioner Coding Auditor to join their team. This role offers the flexibility of mostly remote work within the Eastern Time Zone, allowing you to inspect medical documentation with a focus on clinical and coding accuracy. You will play a critical role in ensuring compliance with CMS standards while providing feedback to enhance provider education. If you have a passion for healthcare and a commitment to excellence, this position provides an exciting opportunity to make a significant impact in the lives of patients and healthcare providers alike.

Qualifications

• Master's degree or NP certificate required.
• 3+ years clinical experience as a Nurse Practitioner.
• Expertise in ICD-10 and coding methodologies.

Responsibilities

• Review medical records for coding accuracy and compliance.
• Communicate audit findings to clinical teams.
• Maintain knowledge of coding and compliance standards.

Skills

ICD-10 coding

Clinical auditing

Communication skills

Detail-oriented

Customer service mindset

Time management

Education

Master of Science in Nursing

Doctor of Nursing Practice

National certification from AANP or ANCC

Job description

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Join to apply for the Nurse Practitioner, Coding Auditor role at Personalized Health Partners

Personalized Health Partners is currently recruiting Nurse Practitioner Coding Auditors. These positions can be mostly remote and work from anywhere within the Eastern Time Zone.

The PHP Nurse Practitioner Coding Auditor has a passion for inspecting medical documentation for clinical and coding accuracy. The nurse practitioner coding auditor will review documentation of PHP providers for accuracy and provide feedback to clinical leadership and education to providers based on audit findings.

Job Summary

The primary role of the Nurse Practitioner Coding Auditor is to review and assess the accuracy, completeness, specificity, and appropriateness of diagnosis codes identified in the medical record completed by Personalized Health Partner clinical providers. This role also involves understanding the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) and communicating audit findings with providers to ensure optimal accuracy. Responsibilities include:

1. Review medical records within required timelines to ensure completion and compliance with CMS and coding best practices.
2. Assess the accuracy, completeness, specificity, and appropriateness of diagnosis codes in medical records.
3. Communicate promptly with coding leadership and clinical teams regarding issues or corrections.
4. Understand the relationship between ICD-10-CM coding and HCC coding.
5. Integrate coding compliance standards into practices.
6. Identify, correct, and report coding issues.
7. Maintain knowledge of coding, compliance, and reimbursement procedures related to Medicare risk adjustment.
8. Make recommendations for coding policy or changes.
9. Follow all legal and policy requirements for HIPAA data.
10. Demonstrate teamwork consistently.
11. Maintain strong familiarity with the Coding Clinic.
12. Apply expert understanding of coding guidelines with sound judgment.

Education and Qualifications

Required:

• Master of Science in Nursing, Doctor of Nursing Practice, or NP Certificate Program graduate.
• National certification from AANP or ANCC.
• Active, unrestricted state license(s).
• Ability to obtain licensure in additional states as needed (telehealth providers must be licensed in OH, IN, WV, MD, VA, PA).
• Active DEA license.
• US work authorization.
• At least 3 years of clinical experience as a Nurse or Nurse Practitioner in geriatric, adult, or family practice.
• Ability to work flexibly.
• Passion for providing healthcare to senior and low-income populations.

Preferred Qualifications:

• Over 3 years of clinical experience as a Nurse Practitioner.
• Experience with coding & auditing for over 3 years.
• Expertise in ICD-10, risk adjustment/HCC, and CPT coding methodologies.
• Training or clinical experience in geriatrics.
• Experience in a metrics-driven healthcare model.
• Willingness to pursue professional development and certifications.
• Experience with value-based care models.
• Experience in geriatric, assisted living, or skilled nursing settings.
• Experience working collaboratively to achieve healthcare outcomes.
• Training or experience in outpatient primary care settings.

Job Skills

• Strong oral and written communication skills.
• Detail-oriented with ability to work independently and in teams.
• Customer service mindset.
• Excellent time management to prioritize tasks and meet deadlines.