Job Information

AdventHealth Virtual PE Coding Auditor in Altamonte Springs, Florida

Description

AdventHealth Corporate

Location Address: Virtual, local to Central Florida

All the benefits and perks you need for you and your family:

  • Benefits from Day One

  • Career Development

  • Whole Person Wellbeing Resources

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full-Time

The role you’ll contribute:

The Auditor is responsible for reviewing medical record documentation making sure that the CPT, ICD-10 and HCPCS codes and modifiers are correct for the selected claims. The Auditor will follow AH policies and procedures for annual audit schedules for both physicians and practices. The Auditor is responsible for completing professional reports of their findings and delivering those results to physicians and leadership.

The value you’ll bring to the team:

  • Utilizing Expert auditing knowledge, interprets and reviews medical record documentation to make sure the accurate ICD-10, CPT, HCPCS and modifiers are assigned based on provider documentation.

  • Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines

  • Provides education to providers, practice staff, and coders as needed based on audit results, coding updates and documentation needs.

  • Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II and CMS guidelines.

  • Demonstrate expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.

  • Maintains an accuracy rate of 90% or above for all work Quality Assurance reviews.

  • Complete assigned work in a timely manner and maintain departmental production standards.

  • Critical thinking and problem-solving skills are essential along with the ability to work independently, remotely and with minimal supervision. Must be self-motivated and able to use electronic resources.

  • Responsible for accurately interpreting and communicating Federal guidelines and educating based on CMS sources.

  • Serves as an expert resource to coding managers and supervisors.

  • Create, prepare, and present educational materials on a wide variety of coding and billing topics to be presented to the multiple departments to internal team, physicians, and leadership.

  • Utilizes a high degree of coding knowledge based in multiple medical service lines as well as multiple specialties throughout the Organization.

  • Review highly complex escalated surgical cases, to be reviewed with Corporate Responsibility, Legal and Physicians.

  • Identify coding trends based on audit results and communicate with Coding Integrity Manager and Corporate Responsibility to determine appropriate next steps.

  • Ability to connect effectively with practice leadership, Corporate Responsibility and Revenue Cycle to answer and assist on coding and documentation topics

Qualifications

The expertise and experiences you’ll need to succeed:

  • Certified Professional Coder (CPC) or Certified Coding Specialist – Physician (CCS-P) AND Certified Professional Medical Auditor (CPMA)

  • High School Diploma or equivalent required.

  • Five or more years of experience in physician-based coding for both E&M (outpatient/inpatient) and surgical procedures.

  • At least three years of certified auditing experience

  • Expert knowledge of ICD-10, CPT, HCPCS, and coding, along with modifiers for outpatient and inpatient procedures.

  • Expertise in auditing using both the 1995 and 1997, and 2021 E/M CMS Guidelines

  • Extensive knowledge of NCCI, MU, MUE edits and bundling guidelines.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Physician Services

Organization: AdventHealth Corporate

Schedule: 1 - Day

Shift: AdventHealth

Req ID: 21044004

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