The Physician Coding Auditor performs coding related audits to monitor professional coding to ensure optimal efficiency and follow the controlling compliance guidelines with governmental and private payers. The Physician Coding Auditor is responsible for analyzing Physician and Coder charges for Surgical, procedural and E/M based coding.
Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.
Competitive Pay
All Inclusive Benefits (start day one)
Forbes Recognizes Orlando Health as a Best-In-State Employer
Employee-centric
Responsibilities
Responsible for internal auditing and analyzing professional coding for all service lines.
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.
Perform 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.
Maintains compliance with all Orlando Health policies and procedures.
Qualifications
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.
Must maintain one (1) of the following nationally recognized certifications:
CPMA certification required through the American Academy of Professional Coders or 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
Five (5+) years of professional based coding experience in multiple specialties is required.
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.
Must be detail oriented and able to follow through on issues to resolution.
Must be able to act both independently and as a team member.
Ability to work independently