Coding Auditor and Educator, Physician Billing (PB)

About the role

The Physician Billing (PB) Coding Auditor and Educator is responsible for auditing and educating healthcare providers on related applicable clinical documentation. This work supports coding and billing regulations that ensure appropriate reimbursement, public reporting, and various initiatives as directed by the Hackensack Meridian Health (HMH) Network.

Responsibilities

• Comply with established corporate and departmental policies, procedures, objectives, quality assurance methods, and safety codes. Demonstrate compliance with licensing, regulatory, and accrediting agency provisions as required.
• Perform coding quality audits of all records (outpatient, inpatient, procedures, diagnostic testing) to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers and staff.
• Create spreadsheets and summaries of audit findings.
• Aid providers, practices, internal/external coding team(s), revenue cycle analysts (RCA), and Training Teams with coding inquiries.
• Clarify complex discrepancies in documentation and coding; assure accuracy and timeliness of coding assignments to expedite the billing process and facilitate data retrieval for physician access and ongoing patient care.
• Perform follow-up complex coding of medical records per internal or external audits identified as Coding discrepancies.
• Maintain annual mandatory education requirements specific to the position as mandated by HMH.
• Keep abreast of coding guidelines and reimbursement reporting requirements, new technology, and procedures in accordance with the CMS and Office of Inspector General (OIG) regulations.
• Bring identified concerns to the department manager and Director for resolution.
• Participate in other special projects, duties and/or projects as assigned.
• Adhere to HMH Organizational competencies and standards of behavior.

Qualifications

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Minimum of 5 years of Physician Coding experience in a large multi-specialty group.
• Experience and thorough knowledge of ICD-10 and CPT coding.
• Knowledge of data reporting requirements and proficiency in computer skills.
• Extensive knowledge in data collection and physician coding reviews.
• Must have advanced coding education and training with a strong foundation in E/M Coding.
• Knowledge of Coding software and Google Suite: Sheets, Slides, and Docs.
• Excellent oral and written communication skills.
• Ability to work independently in a fast-paced environment.
• Ability to interact with management personnel and the provider community.

Education, Knowledge, Skills and Abilities Preferred

• Associate's degree or higher.
• Minimum of 2 years of physician quality improvement auditing/education experience.
• Licenses and Certifications Required:
• Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); or Certified Professional Coder (CPC) Certification.
• Certified Professional Medical Auditor (CPMA) at hire or must obtain within one (1) year of hire.
• Licenses and Certifications Preferred:
• Certified Risk Adjustment Coder (CRAC).