Physician Coding Auditor

Department Patient Accounting
- Physicians

Status Full Time

Shift Remote

Location Orlando, FL

Title Physician Coding Auditor

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.

Orlando Health information:
Forbes has named Orlando Health as one of America s Best-In-State Employers. Orlando Health is committed to providing benefits beyond the expected, including education programs and wellbeing services. Benefits begin on day one where possible.

• Responsible for internal auditing and analyzing professional coding for all service lines.
• Monitor audit results to identify potential coding inaccuracy.
• Provide Educators the needed support in identifying coding errors.
• Provide 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.
• Provide feedback to physicians, non-physician providers, physician office staff, administration, practice managers, and team members regarding best practices to ensure physician coding compliance.
• Collaborate with Physician Coding Education Team to ensure appropriate and complete coding accuracy for payor guideline reimbursement.
• Utilize resource material available in department, CMS, AMA, AHCA and federal registry to support coding practices.
• Maintain patient and coder confidentiality of audit results.
• Collaborate with physician coding leadership for monitoring coding quality.
• Participate in Health Plan Audits.
• Follow and adhere to Standards of Ethical Coding, applicable regulations and guidelines, and client policies.
• Perform physician queries for coding and documentation clarification during concurrent chart review.
• Serve as a resource to new coders.
• Maintain professional demeanor and dress when addressing all Orlando Health departments.
• Proficiency in coding including ICD-10, CPT, E/M, modifiers with a target accuracy of 90%.
• Maintain compliance with all Orlando Health policies and procedures.

• Attend payor, departmental and interdepartmental meetings as required.
• Perform other duties as assigned based on organization needs and projects.
• Collaborate on testing, training, and mentoring incoming coders according to coding guidelines and individual skills for the division.
• Conduct focused physician reviews as needed and provide data to manager.

• High School diploma or equivalent
• Exceptional knowledge in Microsoft Office Suite
• Thorough knowledge of official coding guidelines as per AMA, AHCA, and CMS demonstrated by coding skills test of 90% or better

Must maintain one (1) of the following nationally recognized certifications

• CPMA certification required through the American Academy of Professional Coders
• Five (5+) years auditing experience in lieu of CPMA with expectation to acquire CPMA within 1 year of hire
• Coding Credential required AHIMA or AAPC credential
• CEMA certification via National Alliance of Medical Auditing Specialists

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

• Strong research, organizational, multi-tasking, planning, problem-solving and critical thinking skills
• Excellent collaboration, verbal, and written communication skills with providers, leadership, and team members
• Excellent knowledge of medical terminology, CPT, ICD-10-CM/PCS and HCPCS coding principles, governmental regulations, protocols, and third-party payer requirements
• Expert Coding (CPT and ICD-10-CM) and auditing
• Experience with Electronic Medical Records, EPIC experience preferred
• Excellent written and verbal communication and interpersonal skills
• Strong organizational, multi-tasking, and time-management skills
• Detail oriented and able to follow through on issues to resolution
• Ability to work independently and as part of a team