Professional Coding and Billing Auditor
9 hours ago
We are seeking a highly skilled Coding and Billing Auditor to join our team at Care New England Health System. As a key member of our compliance team, you will be responsible for ensuring that our coding and billing practices are in compliance with federal and state regulations, as well as private payor health care program requirements.
Key Responsibilities- Conduct compliance audits for risk areas identified through internal data analysis and external sources.
- Ensure all coding, billing, and documentation comply with federal and state regulations, private payor health care program requirements, and Care New England Compliance policies.
- Develop and implement training programs to assist in achieving Care New England's goal of an effective compliance program.
- Assist with new provider on-boarding education.
- Consistently demonstrate a comprehensive, expert-level knowledge of all professional fee coding in accordance with federal and state rules and regulations, CMS, AMA, CPT, ICD-10-CM, and HCPCS Level II procedure and supply codes coding guidelines.
- Effectively review/audit medical records with focus on Evaluation and Management services to identify opportunities for clinical documentation improvement and potential coding opportunities to optimize reimbursement.
- Correctly identify and implement education and training opportunities related to coding for physicians and non-physician providers based on results of chart reviews under the direction of Care New England Medical Group management team.
- Be consistently available as a subject matter expert for coding guidelines, questions, and other issues from Care New England providers and staff.
- Associate degree in Business Management or Health Care Management or a minimum of 3-5 years experience, with a strong emphasis on evaluation and management documentation, coding, billing, and auditing, preferably for a medium to large physician practice group or health system.
- Multiple specialty coding experiences, including behavioral health preferred. Bachelors degree preferred.
- A high-level knowledge of medical terminology, anatomy, and pathophysiology, along with understanding of the proper application of CPT procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes.
- Excellent verbal and written communication skills.
- Proficient knowledge of MS Word, Excel, and PowerPoint required.
- Evaluation and management coding and auditing expertise.
- Knowledge of billing, coding, clinical documentation regulations, and regulatory guidelines.
- Proficient with technology and software tools, including but not limited to Epic and Cerner systems, and auditing tools such as MDAudit.
- Required: Certified Professional Coder (CPC). Certified in Healthcare Compliance (CHC) within 12 months of hire.
- Preferred: Certified Professional Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA)
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