Nurse Practitioner, Coding Auditor

CommuniCare Health; Linthicum (MD); Remote; USD 80,000 - 110,000; Full time

Job summary

An established industry player is seeking a dedicated Nurse Practitioner Coding Auditor to ensure the accuracy of medical documentation. This role involves reviewing clinical records, providing feedback to enhance coding practices, and ensuring compliance with CMS standards. The ideal candidate will have a strong background in nursing, coding expertise, and a passion for improving healthcare delivery. Join a forward-thinking organization that values teamwork and professional growth while making a significant impact on patient care in a flexible, remote-friendly environment.

Qualifications

• 3+ years clinical experience as a Nurse or Nurse Practitioner required.
• Expertise in ICD-10, risk adjustment/HCC, and CPT coding methodologies preferred.

Responsibilities

• Review and assess accuracy of diagnosis codes in medical records.
• Communicate audit findings effectively with clinical teams.

Skills

Oral Communication Skills

Written Communication Skills

Detail Oriented

Time Management

Education

Master of Science in Nursing

Doctor of Nursing Practice

NP Certificate Program

Tools

ICD-10 Coding

CPT Coding

Coding Compliance Standards

Job description

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:

• Reviews medical records within required timelines to determine completion and compliance with CMS and coding best practices.
• Reviews and assesses the accuracy, completeness, specificity, and appropriateness of diagnosis codes identified in the medical record.
• Communicates timely and effectively with the coding leadership and the clinical team regarding issues or corrections with the medical record.
• Understands the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding.
• Demonstrates a commitment to integrating coding compliance standards into coding practices.
• Identifies, corrects, and reports coding problems.
• Maintains adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare risk adjustment.
• Makes recommendations for coding policy/changes.
• Follows all legal and policy requirements for HIPAA protected data.
• Actively demonstrates teamwork at all times.
• Strong familiarity with the Coding Clinic.
• Expert level understanding of coding guidelines and is able to use and apply appropriate judgment.

EDUCATION and QUALIFICATION:

Required:

• Master of Science in Nursing, Doctor of Nursing Practice, or NP Certificate Program graduate.
• National certification of AANP or ANCC.
• Active, unrestricted state license/s.
• Ability to obtain licensure in additional states in 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 setting.
• 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 preferred with coding & auditing experience.
• Expertise and experience in ICD-10, risk adjustment/HCC, and CPT coding methodologies.
• Training or clinical experience in geriatrics.
• Experience or training working in a metrics, results driven healthcare model.
• Be open to professional development through training, obtaining certifications if necessary, and attending team meetings.
• Experience working in value-based care models.
• Training or experience in geriatric, assisted living, and/or skilled nursing setting.
• Experience working in a collaborative healthcare setting to drive positive outcomes and achieve goals.
• Training or experience in outpatient primary care setting.

JOB SKILLS

• Must have strong oral and written communication skills.
• Must be detail oriented with an ability to work well both independently and in a team setting.
• Exhibit a customer service approach with teams and residents.
• Strong time management skills required. Must be able to prioritize and adhere to competing deadlines while achieving goals.