Virtua Health
Profee Clinical Data Quality Admin (CDQA) / Coding Auditor / Coding Educator for
Virtua Health, Mount Laurel, New Jersey, United States
Job Title
Profee Clinical Data Quality Admin (CDQA) / Coding Auditor / Coding Educator for Virtua Medical Group - CPC (Remote) Location
100% Remote Job Summary
Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. Includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders. Works with VMG practices to resolve coding issues that prevent accounts from being processed appropriately. Responsible for developing, implementing and maintaining a compliance plan for pro-fee coding and abstracting. Position Responsibilities
Training and Education: Providing training and education for newly hired coders, using the medical record with rules and regulations to properly code VMG encounters. Audits new coders once they are 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.). External Coding Audit Response: Trains new coders to utilize the medical record, clinical, coding and abstracting systems in accordance with UHDDS and other rules and regulations to properly abstract and code all HIM coded inpatient and outpatient accounts; conducts exit interviews with external auditors; prepares rebuttals and appeals; takes appropriate action with responses (including correcting data and educating providers and coders). Responds to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Conducts onboarding education of clinicians billing under VMG TIN (CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines). Auditing: Performs chart audits to review CPT, ICD-10-CM and HCPCS codes, provides timely feedback to staff and director. Oversees the annual external audit process for all clinicians that bill under the VMG TIN; creates audit samples, communicates results to clinicians and provides annual coding education. Audits clinicians who scored below 80% on external audits. Reviews work queue edits for provider coding trends and education needs. Educates clinicians based on chart audit and coding trends. Accounts Receivable: Monitors pre-AR aging reports; troubleshoots and resolves complex problems to facilitate appropriate AR reductions; codes charts when needed to support AR goals. Collaborates with Practice Directors and Practice Managers to improve operational workflows related to clinician coding. Review and Resolution of Interdepartmental Coding-Related Issues: Works with VMG Practices and third-party billing company to resolve coding and reimbursement issues; serves as escalation point; educates staff on pro-fee coding requirements; recommends workflow changes to ensure documentation and reimbursement. Policies and Procedures: Develops and enforces policies and procedures for coding, data abstraction and compliance; recommends changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement; monitors and reports on productivity and quality standards. Qualifications
3 years professional fee (provider) coding or a combination of 3 years professional fee coding and healthcare auditing experience. Subject matter expertise in CPT, ICD-10-CM and HCPCS coding; ability to develop and present education presentations. Coding Certificate Program or equivalent experience leading to appropriate certification; CPC Certification by AAPC required; CPMA Certification by AAPC preferred. Knowledge of PC database applications, Microsoft Office; encoder experience preferred. Experience in professional fee auditing and education; multi-specialty professional fee coding experience preferred. Onboarding education experience for clinicians billing under VMG TIN including CMS 1995, 1997 and AMA 2021 guidelines. Salary and Benefits
Annual Salary: $65,000 - $103,758. Benefits include medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave, short-term disability and optional long-term disability; life insurance; tuition assistance; employee assistance program with counseling. Eligibility per plan documents and policies. Employment Type
Full-time Seniority level
Mid-Senior level
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Profee Clinical Data Quality Admin (CDQA) / Coding Auditor / Coding Educator for Virtua Medical Group - CPC (Remote) Location
100% Remote Job Summary
Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. Includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders. Works with VMG practices to resolve coding issues that prevent accounts from being processed appropriately. Responsible for developing, implementing and maintaining a compliance plan for pro-fee coding and abstracting. Position Responsibilities
Training and Education: Providing training and education for newly hired coders, using the medical record with rules and regulations to properly code VMG encounters. Audits new coders once they are 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.). External Coding Audit Response: Trains new coders to utilize the medical record, clinical, coding and abstracting systems in accordance with UHDDS and other rules and regulations to properly abstract and code all HIM coded inpatient and outpatient accounts; conducts exit interviews with external auditors; prepares rebuttals and appeals; takes appropriate action with responses (including correcting data and educating providers and coders). Responds to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Conducts onboarding education of clinicians billing under VMG TIN (CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines). Auditing: Performs chart audits to review CPT, ICD-10-CM and HCPCS codes, provides timely feedback to staff and director. Oversees the annual external audit process for all clinicians that bill under the VMG TIN; creates audit samples, communicates results to clinicians and provides annual coding education. Audits clinicians who scored below 80% on external audits. Reviews work queue edits for provider coding trends and education needs. Educates clinicians based on chart audit and coding trends. Accounts Receivable: Monitors pre-AR aging reports; troubleshoots and resolves complex problems to facilitate appropriate AR reductions; codes charts when needed to support AR goals. Collaborates with Practice Directors and Practice Managers to improve operational workflows related to clinician coding. Review and Resolution of Interdepartmental Coding-Related Issues: Works with VMG Practices and third-party billing company to resolve coding and reimbursement issues; serves as escalation point; educates staff on pro-fee coding requirements; recommends workflow changes to ensure documentation and reimbursement. Policies and Procedures: Develops and enforces policies and procedures for coding, data abstraction and compliance; recommends changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement; monitors and reports on productivity and quality standards. Qualifications
3 years professional fee (provider) coding or a combination of 3 years professional fee coding and healthcare auditing experience. Subject matter expertise in CPT, ICD-10-CM and HCPCS coding; ability to develop and present education presentations. Coding Certificate Program or equivalent experience leading to appropriate certification; CPC Certification by AAPC required; CPMA Certification by AAPC preferred. Knowledge of PC database applications, Microsoft Office; encoder experience preferred. Experience in professional fee auditing and education; multi-specialty professional fee coding experience preferred. Onboarding education experience for clinicians billing under VMG TIN including CMS 1995, 1997 and AMA 2021 guidelines. Salary and Benefits
Annual Salary: $65,000 - $103,758. Benefits include medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave, short-term disability and optional long-term disability; life insurance; tuition assistance; employee assistance program with counseling. Eligibility per plan documents and policies. Employment Type
Full-time Seniority level
Mid-Senior level
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