Nurse Practitioner, Coding Auditor

Personalized Health Partners; Indianapolis (IN); Remote; USD 70,000 - 95,000; Full time

Job summary

An innovative healthcare organization is seeking a dedicated Nurse Practitioner Coding Auditor to ensure the accuracy and compliance of medical documentation. This role involves reviewing clinical records, providing feedback to clinical teams, and ensuring adherence to coding standards. Ideal candidates will have a strong background in nursing, coding, and auditing, with a passion for improving healthcare quality for senior and low-income populations. Join a forward-thinking team that values flexibility and professional development while making a significant impact in the healthcare sector.

Qualifications

• Master's degree in Nursing or NP Certificate Program required.
• 3+ years clinical experience as a Nurse or Nurse Practitioner.

Responsibilities

• Review medical records for compliance with coding best practices.
• Communicate audit findings to clinical leadership and providers.
• Maintain knowledge of coding and reimbursement procedures.

Skills

ICD-10 Coding

Clinical Experience

Attention to Detail

Communication Skills

Time Management

Education

Master of Science in Nursing

National Certification (AANP or ANCC)

Active DEA License

Job description

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

Get AI-powered advice on this job and more exclusive features.

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. In addition, this role will be responsible for understanding the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) and communicating audit findings with the providers so that optimal accuracy can be assured. The responsibilities of the auditor in this role will include, but are not limited to:

1. Review medical records within required timelines to determine completion and compliance with CMS and coding best practices.
2. Assess the accuracy, completeness, specificity, and appropriateness of diagnosis codes in the medical record.
3. Communicate timely and effectively with coding leadership and the clinical team regarding issues or corrections with the medical record.
4. Understand the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding.
5. Demonstrate a commitment to integrating coding compliance standards into coding practices.
6. Identify, correct, and report coding problems.
7. Maintain adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare risk adjustment.
8. Make recommendations for coding policy/changes.
9. Follow all legal and policy requirements for HIPAA protected data.
10. Actively demonstrate teamwork at all times.
11. Possess strong familiarity with the Coding Clinic.
12. Exhibit expert-level understanding of coding guidelines and apply appropriate 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 within the service area as requested (telehealth providers required to be licensed in OH, IN, WV, MD, VA, PA).
• Active DEA license.
• US work authorization.
• 3+ years clinical experience as a Nurse or Nurse Practitioner in geriatric, adult, or family practice.
• Ability to work in a flexible environment and schedule.
• Passionate about providing healthcare to the senior and low-income populations.

Preferred Qualifications:

• 3+ years clinical experience as a Nurse Practitioner.
• 3+ years of experience with coding & auditing preferred.
• Expertise in ICD-10, risk adjustment/HCC, and CPT coding methodologies.
• Training or clinical experience in geriatrics.
• Experience working in a metrics, results-driven healthcare model.
• Open to professional development through training, obtaining certifications, and attending team meetings.
• Experience in value-based care models.
• Training or experience in geriatric, assisted living, and/or skilled nursing settings.
• Experience working collaboratively to drive outcomes and achieve goals.
• Training or experience in outpatient primary care settings.

Job Skills

• Strong oral and written communication skills.
• Attention to detail with the ability to work independently and in teams.
• Customer service approach with teams and residents.
• Strong time management skills to prioritize and meet deadlines.