Address
Form of workCODING AUDITOR
About US Eye:
US Eye is a premier eye care platform that provides vertically integrated care across the patient continuum, through its optometry and ophthalmology practices, as well as surgery centers. With over sixty clinics and five surgery centers spanning four states, US Eye is committed to providing highest quality care to patients. The company currently employs over 100 skilled clinicians and over 1,00 dedicated team members.
JOB SUMMARY:
The Coding Auditor is responsible for implementing a comprehensive audit protocol to audit and determine the integrity of coding and billing processes, detection and correction of documentation, coding and billing errors and/or medical necessity of services billed for physician and clinic fees. In addition, Coding Auditor will research current federal (CMS), state Local Coverage Determinations and fiscal intermediaries (First Coast/Palmetto) to further educate physicians, providers and staff regarding the updates on billing and coding to ensure compliance.
Reporting directly to the General Counsel & Compliance Officer, this role in enterprise-wide and will have regular interaction with all departments, providers and relevant staff.
ESSENTIAL JOB FUNCTIONS:
- Build a regular, consistent audit protocol and process across all employed and/or contracted providers.
- Develop and execute provider comprehensive educational opportunities/curriculums, coding resources, materials, webinars, campaigns, etc.
- Leads provider education events to discuss overall audit results, note trends and changes within coding compliance and regulatory guidelines.
- Provides support or project management for any other related audit and coding initiatives and assist in other related responsibilities as required by executive leadership team.
- Participates in the development, implementation, and ongoing compliance monitoring of the Compliance Plan.
- Maintains current knowledge of applicable federal and state regulations, bulletins and code changes as well as updates from fiscal intermediaries.
- Serves as billing/coding resource to the organization regarding compliant billing practices.
COMPETENCIES:
Business and Industry Acumen
- Strong knowledge of E&M regulations and CMS documentation guidelines.
- Successful experience with data abstraction to analyze patient encounters for focused review, sample and development of coding education materials and resources.
- Proficient in ICD10CM, CPT and HCPCS coding, policy and procedures based on physician practices.
- Demonstrates general understanding of the business, industry and organization.
- Demonstrates ability to redirect issues to appropriate resources.
Personal Effectiveness and Credibility
- Communicates verbally and in writing effectively with staff and providers.
- Demonstrates strong research and data interpretation skills/secondary research resources (i.e., Internet).
- Maintains appropriate degree of confidentiality.
- Demonstrates interpersonal skills.
- Demonstrates a strong self-initiative and self-motivation.
- Demonstrates effective time, organizational and prioritization skills.
- Demonstrates team skills and respects differences.
- Demonstrates presentation and writing skills.
- Comfortable working independently with little or no supervision.
- Demonstrated organization, facilitation, written and oral communication, and presentation skills.
EDUCATION AND EXPERIENCE:
- High School degree or GED
- Prior Physician Coding & Auditing experience or prior Revenue Cycle/billing experience related to Coding.
- At least 2 years of professional E&M coding experience and 2 years of E&M provider education experience.
- Expert Licenses & Certifications: AAPC Certified Professional Coder, AAPC Certified Professional Medical Auditor, AHIMA Certified Coding Specialist-Physician-based
- Upon Hire, CPC-Certified Professional Coder and/or CCS-P-Certified Coding Specialist-Physician required.
- CPMA-Certified Professional Medical Auditor must be completed within 1 year.
POSITION TYPE AND EXPECTED HOURS OF WORK:
- This is a full-time, remote position.
PHYSICAL DEMANDS:
- Prolonged periods of sitting at a desk and working on a computer.
BENEFITS:
401(K) Company Match
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
Medical and Dental Insurance
Vision Benefits
Flexible Spending Accounts
Pet Insurance
Disability Insurance
Life Insurance
Continuing Education
Paid Time Off
US Eye provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
