Physician Coding Auditor

Responsibilities

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor the audit results closely to identify any potential coding inaccuracy.
• Provides the Educators the needed support in identifying coding errors.
• Provides results or trends with Education Team for physician education.
• Review medical records to ensure coding accuracy.
• Identify and communicate physician documentation and coding opportunities for improvement.
• Provides feedback to physicians, non-physician providers, physician office staff, administration, practice managers, and team members of the Physician and Professional Services Central Business Office regarding best practices to ensure physician coding compliance.
• Collaborates with Physician Coding Education Team to ensure appropriate and complete coding accuracy for payor guideline reimbursement.
• Utilizes resource material available in department, CMS, AMA, AHCA and federal registry to support coding practices.
• Maintains patient and coder confidentiality audit results.
• Collaborate with physician coding leadership for monitoring coding quality.
• Participate in Health Plan Audits.
• Follow and adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Performs physician queries for coding and documentation clarification during concurrent chart review process.
• Serves as a resource to new coders.
• Addresses all Orlando Health departments professionally and positively, in all settings, by always maintaining a high level of professional demeanor and dress.
• Proficiency in coding including ICD-10, CPT, E/M, modifiers while maintaining a 90% accuracy.
• Adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.
• Attends payor, departmental and interdepartmental meetings as required.
• Other duties as assigned based on organization needs and projects.

Qualifications

• Education/Training: High School diploma or equivalent
• Possesses exceptional knowledge in Microsoft Office Suite
• Thorough knowledge of official coding guidelines as per AMA, AHCA, and CMS as evidenced by results of coding skills test of 90% or better.
• Licensure/Certification: Must maintain one (1) of the following nationally recognized certifications: CPMA certification required through the American Academy of Professional Coders
• Five (5+) years auditing experience in lieu of CPMA with expectation to acquire CPMA within 1 years of hire.
• Coding Credential Required: AHIMA or AAPC credential. CEMA certification via National Alliance of Medical Auditing Specialists
• Experience: Five (5+) years of professional based coding experience in multiple specialties is required.

Skills

• Knowledge: Strong research, organizational, multi-tasking, planning, problem-solving and critical thinking skills
• Excellent collaboration, verbal, and written communication skills with providers, leadership, and team members
• Excellent knowledge of medical terminology, CPT, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and third-party payer requirements pertaining to billing, coding, and documentation
• Expert Coding (CPT and ICD-10-CM) and auditing
• Experience working with Electronic Medical Records, EPIC experience preferred
• Excellent communication (written and oral) and interpersonal skills
• Strong organizational, multi-tasking, and time-management skills
• Able to work independently and as a team member
• Able to act both independently and as a team member