Coding Auditor, Physician Group

Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

Responsible for the creation and maintenance of audit and education programs that will ensure success for all staff and
employed providers based on their specific needs and support accurate, compliant coding practices for ECU Health
Physicians in accordance with coding guidelines. Conducts internal auditing of medical coding activities using
concurrent, prospective and retrospective models as appropriate and/or required. Reviews electronic health
information to determine accuracy of coding, billing and documentation, including validation of ICD10CM, CPT, HCPCS
and modifier assignment related to medical provider professional Part B services according to regulatory and
institutional policy. Reports findings, both written and verbal, to leadership as necessary to include provision of
corroborating regulatory or policy guidance. Maintains documentation of all audit activities and communicates the
findings with leadership. Utilizes findings to generate topics for education and training, including code assignment,
process improvement, system logic, risk reduction and reimbursement optimization. Develops and coordinates
education based on the specific needs of the individual or functional unit. Provides orientation and education to new
provider hires. Assists coding leadership with education, training and review of coding personnel activities as needed.

Responsibilities

Auditing

Performs coding audits on professional fee encounters to determine accuracy of ICD10CM, CPT, HCPCS codes and modifiers
selected for claim submission. Frequency of audits and volume of encounters audited will be established in accordance
with organizational policy.
Documents details of audit findings in auditing software. Prepares and distributes reports of audit findings.
Provides information to leadership on the status of coding audits and all related activity.
Takes initiative to analyze, investigate and research regulatory topicsfor guidance to efficiently and effectively develop
educational plans.Guidance includes but is not limited to CMS, NC Medicaid, AMA CPT, organization policy or other
governing bodies as it relates to provider documentation and medical coding.
Assists with updating and developing Medical Group coding policies and procedures and other duties as assigned.

General Coding Education

Develops focusededucational materials, including but not limited to presentations, training classes, tip sheets, etc. based
on needs as outlined and/or requested by leadership.
Provides individualizedtraining based on audit results. Provides ongoing support and education to individuals falling below
organizational assigned performance levels.
Ensures all staff and employed providers engaged in coding and billing activities are appropriately and timely updated on
changes in medical coding and reimbursement laws, regulations and guidelines.
Prepares and conducts education upon request for providers, coding staff and external departments related to recognized
documentation policy,medical coding guidelines, and billing requirements.
Serves as an expert resource for questions on compliant coding practices and researching regulatory topics for guidance.

New Hire Orientation and Education

Participates in education of new providers and/or coding staff.
Participates in education of students as a part of student internship experiences.

Revenue Integrity

Works closely with leadership to identify trends and areas of vulnerability.
Identify areas of revenue integrity opportunities via routine audits as well as via special-request audits.

Minimum Requirements

At least 5 years of multidisciplinary physician based coding or auditing experience required.

Bachelor's Degree in Health Information Management or Associates Degree in Health Information Technology or Medical Office Administration required, or higher.

RHIA, RHIT, CCS, CPC, or CCS-Pcertification required.

CCS, CCS-P or CPC and a minimum of 8 years of physician based coding or documentation audit experience may be substituted for the education requirement.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.