Virtua Health · 8 hours ago
Lead VMG Coding Auditor & Educator
Marlton, NJ
Full-time
Onsite
Mid, Senior Level
3+ years expVirtua Health is seeking a Lead VMG Coding Auditor & Educator to oversee professional fee coding quality audits and provide education for their clinicians and coding department. This role involves leading audit workflows, managing audit documentation, and coordinating training for coders while ensuring compliance with coding guidelines.
Health Care
Responsibilities
Leads and coordinates all phases of external clinical professional fee coding audit:
Selects audit sample and applies national bell curve in system
Communicates audit results to clinicians and leads
Manages rebuttals
Coordinates and performs post audit education
Coordinates and performs re-audits
Tracks and reports results
Ensures phase schedule of audits and post-audit follow up is tracked and maintained
Maintains all audit documentation and serve as a liaison for internal and external auditors
Lead And Coordinate Internal Coder Professional Fee Audit
Selects audit sample
Assigns auditors as needed
Tracks progress and results
Communicates results to Coding Operations Managers
Leads workflow for the audit and education team who provide training and education for all internal coders
Leads confirmation audit planning for all internal coders once they approved to submit charges in the work queues and provides appropriate feedback
Develops coding and training resources for the entire coding team (modules, scenarios, tip sheets, etc.)
Serves as an escalation point to the education and audit team when responding External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders). to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts
Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines
Coordinates workflow of staff performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director
Performs chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit
Reviews work queue edits for provider coding trends and education needs
Confidently educates clinicians based on chart audit and coding trends
Assists in implementation and maintenance of audit software system
Utilizes software for all audit activities and recommends changes and customization
Maintains Epic records for semi-compliant and non-compliant providers to ensure enhanced review levels are supported within the Epic work queues
Assigns audit and education team members to works closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements
Provides education to their staff, including clinicians and billers on pro-fee coding issues
Recommends changes to workflows to ensure appropriate documentation and reimbursement
Develops policies and procedures on coding, data abstraction and compliance for VMG
Documents and enforces policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff
Recommends changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement
Assists Coding Director with monitoring and reporting on productivity and quality standards
Qualification
Required
3+ years professional fee(provider) coding and healthcare auditing experience required
Professional Fee Auditing And Education Experience Required
Advanced organizational skills – ability to work proactively with multiple priorities
High level of technical proficiency in Word, Excel, PowerPoint, Outlook, EMR systems
Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required
Ability to develop and present education presentations required
Coding Certificate Program, or equivalent experience, leading to appropriate certification
CPC Certification by AAPC required
Preferred
Multi-specialty professional fee coding experience preferred
CPMA Certification by AAPC preferred
Company
Virtua Health
Virtua provides innovative outreach programs that address social challenges affecting health.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dennis W. Pullin
President and CEO
Recent News
The Philadelphia Inquirer
2026-01-08
The Philadelphia Inquirer
2025-12-19
Company data provided by crunchbase