Sr Professional Facility Auditor

Northwell Health; United States; On-site; USD 39,000 - 73,000; Full time

Job summary

Northwell Health is seeking a Senior Professional Facility Auditor for remote work to audit facility and professional coding and ensure documentation supports services rendered. You will review ICD-10, CPT4, HCPCS and UB04 codes, work with leadership to identify trends, and drive improvements in billing accuracy.

Ideal candidates hold CPC/CCS-P/COC/RHIT or RHIA with auditing experience, plus an Associate's degree or higher.

Qualifications

• Advanced knowledge of medical terminology, anatomy, physiology, and federal/state documentation and billing regulations.
• Extensive experience auditing both facility and professional medical coding.
• Proficiency in coding complex encounters and using relevant coding systems and software.

Responsibilities

• Conduct comprehensive audits of ICD-10, CPT4, HCPCS, E/M codes, medical supplies, orders, and UB04/revenue codes for both facility and professional services.
• Lead educational sessions for coders based on audit findings to reinforce compliance with CMS, Medicare, state/federal regulations, and internal policies.
• Stay current with CMS, NGS Medicare, AAPC, and OIG updates, bulletins, and compliance requirements to ensure up-to-date coding standards.
• Collaborate with physician and hospital coding leadership to identify documentation and coding trends, errors, and improvement opportunities.
• Perform accurate coding and charging for complex clinical services, including interventional cardiology, radiology, and vascular procedures.
• Utilize internal systems and applications with a high level of competency to ensure audit accuracy and reporting efficiency.
• Participate in team meetings, ongoing education, and continuous improvement initiatives to support departmental goals.
• Maintain high standards for customer service, teamwork, safety, and compliance.
• Perform additional duties as assigned.

Skills

CPC

CCS-P

COC

RHIT

RHIA

Education

Associate's degree or higher

CIRCC

CCC

Anatomy and Physiology coursework

Job description

Description

Must reside in the following states: AZ, CT, DE, FL, GA, IL, IN, KS, MA, MD, ME, MI, MS, NC, NH, NJ, NY, OH, PA, SC, TN, TX, and VA.

Job Title: Senior Professional Facility Auditor

Department: Facility Charging and Coding

Location: Remote

Employment Type: Full-Time | Non-Exempt

Salary Range: $28 – $53/hour

Northwellis 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 ofNorthwell Health Physician Partners— who are working to change health care for the better.

About The Role

Nuvance Health is seeking a detail-oriented and experienced Senior Professional Facility Auditor to join our Facility Charging and Coding team. In this role, you will perform in-depth audits of facility and professional coding to ensure clinical documentation supports services rendered. Your expertise in medical terminology, anatomy, physiology, regulatory compliance, and coding guidelines will be essential in driving accuracy and improving documentation and billing practices across our organization.

Key Responsibilities

• Conduct comprehensive audits of ICD-10, CPT4, HCPCS, E/M codes, medical supplies, orders, and UB04/revenue codes for both facility and professional services.
• Lead educational sessions for coders based on audit findings to reinforce compliance with CMS, Medicare, state/federal regulations, and internal policies.
• Stay current with CMS, NGS Medicare, AAPC, and OIG updates, bulletins, and compliance requirements to ensure up-to-date coding standards.
• Collaborate with physician and hospital coding leadership to identify documentation and coding trends, errors, and improvement opportunities.
• Perform accurate coding and charging for complex clinical services, including interventional cardiology, radiology, and vascular procedures.
• Utilize internal systems and applications with a high level of competency to ensure audit accuracy and reporting efficiency.
• Participate in team meetings, ongoing education, and continuous improvement initiatives to support departmental goals.
• Maintain high standards for customer service, teamwork, safety, and compliance.
• Perform additional duties as assigned.

Qualifications

Required:

• CPC,CCS-P,COC,RHIT – With Coding/Auditing experience,RHIA – With Coding/Auditing experience
• Outpatient Facility Coding - Auditing will include facility coding for Interventional Radiology, Cardiac Cath, Outpatient Surgery, Observation, & Ancillary
• Advanced knowledge of medical terminology, anatomy, physiology, and federal/state documentation and billing regulations
• Extensive experience auditing both facility and professional medical coding
• Proficiency in coding complex encounters and using relevant coding systems and software

Preferred (Not Required)

• Associate’s degree or higher
• CIRCC & CCC
• Coursework in Anatomy and Physiology

Work Conditions

• Physical Effort: Light – primarily sedentary; may exert up to 10 lbs. of force
• Working Environment: Generally pleasant; no significant occupational risks
• Communication: Daily interaction including verbal, written, and participation in team meetings