Medical Auditor (Billing & Coding)

JOB SUMMARY:

Responsible for conducting coding and documentation audits for assigned providers and consulting and educating providers on documentation requirements and other compliance issues related to billing.

Under the direct supervision of the Billing & Coding Compliance Manager, this full-time position will work with physicians and other clinicians to ensure they comply with documentation and coding standards, regulations and requirements. This includes conducting billing and coding audits, identifying and resolving issues, and educating clinicians and staff on requirements for documenting, coding and billing medical services.

Job Responsibilities and Accountabilities:

• Assists with monitoring of OrthoVirginia’s Compliance Program as related to billing, coding, and documentation, including the OIG Compliance Program guidance for physician practices and third-party billing companies
• Performs audits of coding and billing data for accuracy and compliance with federal regulations
• Conducts physician, APP and scribe coding and documentation education classes as needed/requested
• Educate clinicians, as assigned, in documentation and coding to ensure documentation meets appropriate coding levels
• Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through education, and other educational activities.
• Meets with assigned providers on a regular basis to educate and review results of audits
• Responsible for keeping up to date with all E/M Documentation Guidelines
• Monitors all compliance issues identified during routine audits and recommends areas that indicate a focused audit may be necessary
• Assists with projects as directed

Qualified Candidates must meet all of the following criteria:

• Exemplifies OrthoVirginia’s values – excellence, compassion and unity
• Bachelor’s Degree or equivalent with 5 to 7 years’ experience working as a credentialed coder, preferably in a medical practice
• Licensing, certification/degree as one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Evaluation and Management Coder (CEMC) required
• Thorough knowledge of CPT and ICD coding principles and guidelines
• Knowledge of Medicare and Medicaid rules for documentation of billed services
• Strong analytical and problem-solving skills required including experience auditing
• Ability to exercise initiative, problem-solving and decision-making to effectively plan, prioritize, and complete projects/tasks with little supervision in a fast paced, changing environment
• Specific, thorough understanding of regulatory requirements relating to documentation, claims processing, reimbursement, and coding
• Skilled in establishing and maintaining effective professional working relationships with physicians, advanced practice providers, administration and team members
• Advanced working experience in Microsoft Office including Excel (formulas, pivot tables, dashboards, etc)
• Exceptional written and strong verbal communication skills: face to face, email, written correspondence, telephone

Other:

• Has access to and knowledge of extremely sensitive, private and confidential materials-ability to maintain the highest standard of confidentiality is required with zero tolerance
• Participates in professional developments efforts to ensure currency in health care policies and trends
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Some travel to regional offices will be required

Typical Physical Demands:

Position requires full range of body motion including handling and lifting, manual and finger dexterity and eye-hand coordination. Involves standing and walking. Employee will occasionally be asked to lift and carry items weighing up to 30 pounds. Normal visual acuity and hearing are required. Employee will work under stressful conditions, and work irregular hours. Employee may have frequent exposure to communicable diseases, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinic environment

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