Outpatient Coding Auditor

Nuvance Health; United States; On-site; USD 38,000 - 72,000; Full time

Benefits offered by this job

PTO

Medical Coverage

Dental Coverage

Vision Coverage

Health Savings Account

401(k) Plan

Life Insurance

Wellness Programs

Employee Assistance Program

Team Member Discounts

Job summary

Nuvance Health is seeking a Coding Auditor to perform high-volume internal reviews of physician practice records, ensuring accurate documentation and coding in line with CMS and internal policies.

The role includes delivering education sessions for coders and physicians, collaborating with the Compliance team, and staying up to date with evolving regulations and payer guidelines to support compliant revenue practices.

Qualifications

• Requires advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations.

Responsibilities

• Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.
• Conducts education sessions for coders and physician practices based on audit findings to reinforce proper documentation and coding.
• QA activities auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.
• Collaborates with Compliance on audits, reporting, and issue resolution.
• Keeps current with CMS/NGS/NGS materials, OIG Work Plan, and payer guidelines to ensure compliant practices.

Skills

Auditing

Coding

Documentation

Regulatory compliance

Education sessions

Education

CPC

CPC-H

CCS-P

CPMA

CDEO

Job description

Nuvance Health Coding Auditor Position

Position at Nuvance Health

Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State's largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better.

Purpose

Provides clinician practice coding, billing, and documentation auditing for professional coding at Nuvance Health. Conducts routine quality assurance (QA) audits on Professional Coding team and compiles reports on their accuracy for leadership. Makes recommendations based on audit findings for educational programs for both coding personnel and clinical staff. Requires advanced expertise in medical terminology, anatomy, physiology, documentation, coding guidelines, state, and federal regulations. This includes evaluation and management services (E&M leveling) and surgical specialties.

Essential Responsibilities

• Conducts high volume internal audits of physician practice medical records for documentation and coding accuracy.
• Conducts education sessions for Nuvance coders and physician practices based on the audit findings and as needed to reinforce proper documentation and coding consistent with Nuvance Health policies, State and Federal regulatory and reimbursement guidelines, maintains compliance while optimizing appropriate revenue opportunities
• QA activities including auditing levels of service of surgical coding performed by Outpatient Coding team for accuracy.
• Work closely with the Compliance department on audits, reporting, complaint coding issues etc.
• Research CMS and NGS Medicare regulations, guidelines, bulletins, and other publications for impact to professional services. Monitor listservs such as CMS, Medicare, NGS, AAPC etc. and third-party payers for coding and billing guidelines and regulations, professional peer organizations' practices/policies/guidelines to help keep Nuvance physician practices current with coding and regulatory requirements and accepted compliance practices. Stay current with OIG Work Plan.
• Collaborate with Outpatient Coder team to identify errors, patterns, trends and variations in coding or documentation. Provides recommendations to Supervisor, Manager or Director to improve coding and documentation practices.
• Attends required educational sessions (webinars, conferences etc.) to maintain and enhance coding certification(s)
• Maintain and Model Nuvance Health Values
• Demonstrates regular, reliable, and predictable attendance.
• Performs other duties as required.

Education Skills Experience

Certification from the America Academy Professional Coders (AAPC) or the American Health Information Management Association (AHIMA):

• CPC, CPC-H, or CCS-P required
• Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) required

Working Conditions

• Manual: Some manual skills/motor coord & finger dexterity
• Occupational: Little or no potential for occupational risk
• Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
• Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Salary Range: $27.25 - $51.98 Hourly

Available Benefits

• Paid Time Off (PTO)
• Medical, Dental and Vision Coverage
• Health and Dependent Care Flexible Spending Accounts
• Health Savings Account
• 401(k) Retirement Plan
• Basic Life and AD&D insurance
• Wellness Programs
• Employee Assistance Program
• Team Member Discounts

Available benefits for union positions may vary in accordance with applicable Collective Bargaining Agreements.