Hybrid Coding and Billing Auditor

at Care New England

• Job title: Coding and Billing Auditor
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Providence, United States

About the role

• Professional Coding and Billing Auditor providing audit support and guidance in compliance to Care New England. Collaborating with management, providers, and staff for effective compliance programs.

Responsibilities

• Provides audit support and guidance to management, providers, residents, and support staff in free-standing and facility-based practices.
• Conducts assigned compliance audits for risk areas identified through the analysis of internal data and external sources.
• Ensures all coding, billing, and documentation complies with federal and/or state regulations, private payor health care program requirements as well as the Care New England Compliance policies.
• Responsible for auditing and implementing training programs to assist in achieving Care New England's goal of an effective compliance program.
• Assists with new provider on-boarding education.
• Consistently demonstrates 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 reviews/audits medical records with focus on Evaluation and Management services to identify opportunities for clinical documentation improvement and potential coding opportunities to optimize reimbursement.
• Correctly identifies and implements 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.
• Assists physician practices and provider-based departments as a coding subject matter expert when necessary.
• Provides baseline coding education to newly hired physicians and non-physician providers/clinicians on a timely basis.
• Effectively prioritizes workload to complete job responsibilities.
• Displays ability to adjust priorities based upon understanding of policies and procedures.
• Completes job responsibilities by deadlines, according to established schedules or workflow requirements.
• Evaluates areas in need of improvement and provides input in order to improve current methods, services, programs, or technology.
• Meets departmental productivity standards.
• Assesses, analyzes and reviews information before making decisions and solving problems.
• Discusses findings with management on an ongoing basis.
• Uses proper judgment and knowledge of established practices and procedures when addressing problems or issues.

Requirements

• 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.

Benefits

• Health insurance
• Professional development opportunities