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Care New England · 6 hours ago

Professional Coding & Billing Auditor

Providence, RI

Full-time

Hybrid

Mid Level

3+ years exp

Care New England is a trusted health system that provides advanced medical research and innovative programs. The Professional Coding and Billing Auditor role involves conducting compliance audits, ensuring adherence to coding and billing regulations, and providing education and training to staff and providers.

AssociationHealth Care

H1B Sponsor Likely

Responsibilities

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

Assist physician practices and provider-based departments as a coding subject matter expert when necessary

Provide baseline coding education to newly hired physicians and non-physician providers/clinicians on a timely basis

Effectively prioritize workload to complete job responsibilities. Display ability to adjust priorities based upon understanding of policies and procedures

Complete job responsibilities by deadlines, according to established schedules or workflow requirements

Evaluate areas in need of improvement and provide input in order to improve current methods, services, programs, or technology

Meet departmental productivity standards

Assess, analyze and review information before making decisions and solving problems. Discuss findings with management on an ongoing basis

Use proper judgment and knowledge of established practices and procedures when addressing problems or issues

Qualification

Certified Professional Coder (CPC)Certified in Healthcare Compliance (CHC)EvaluationManagement codingICD-10-CM codingCPT procedure codesHCPCS Level II codesMS WordMS ExcelMS PowerPointEpicCernerMDAuditMedical terminologyAnatomy knowledgePathophysiology knowledgeCommunication skills

Required

AAPC: Certified Professional Coder (CPC) or AHIMA: Certified Coding Specialist (CCS)

Must obtain Certified in Healthcare Compliance (CHC) within 12 months of hire

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

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

Certified Professional Coder (CPC)

Certified in Healthcare Compliance (CHC) within 12 months of hire

Preferred

Multiple specialty coding experiences, including behavioral health

Bachelor's degree

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

Certified Professional Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA)

Company

Care New England

Care New England (CNE) is a non-profit health system, comprising several hospitals in Rhode Island, including Butler, Women & Infants

Founded in 1996

Providence, Rhode Island, USA

5001-10000 employees

http://www.carenewengland.org

H1B Sponsorship

Care New England has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2024 (3)

2023 (2)