Physician Coding Auditor

Position Summary:About Orlando Health
Orlando Health, headquartered in Orlando, Florida, is a not-for-profit healthcare organization with $9.2 billion of assets under management that serves the southeastern United States and Puerto Rico. Founded more than 100 years ago, the healthcare system is recognized around the world for Central Florida’s only pediatric and adult Level I Trauma program as well as the only state-accredited Level II Adult Trauma Center in Pinellas County. It is the home of the nation’s largest neonatal intensive care unit under one roof, the only system in the southeast to offer open fetal surgery to repair the most severe forms of spina bifida, the site of an Olympic athlete training facility and operator of one of the largest and highest performing clinically integrated networks in the region. Orlando Health has pioneered life-changing medical research and its Graduate Medical Education program hosts more than 350 residents and fellows. The 3,888-bed system includes 29 hospitals and emergency departments – 24 of which are currently operational with five coming soon.

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Position Summary*
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.
Responsibilities:Essential Functions

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor the audit results closely to identify any potential coding inaccuracy.
• Provides the Educators the needed support in identifying coding errors.
• Provides results or trends with Education Team for physician education.
• 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
• Ensure data submitted to the Providers and Coders is complete and accurate supported by Regulations and Guidelines
• 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.
• Adhere to Standards of Ethical Coding, all applicable regulations and guidelines, and all client specific policies.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Qualifications:Education/Training

• 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.

Licensure/Certification
Must maintain one (1) of the following national certifications:

• CPMA certification required through the American Academy of Professional Coders o 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.

Experience

• Five (5+) years of professional based coding experience in multiple specialties is required.

Job Type: Full-time