Centra Health
Coding & Audit Specialist-Full time, Days- REMOTE
Centra Health, Lynchburg, Virginia, us, 24513
Coding & Audit Specialist – Full Time, Days – Remote
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Professional Coding and Audit Specialist independently performs audits of Centra Medical Group (CMG) provider documentation and coding of professional evaluation & management (E/M) services to include E/M, International Statistical Classification of Diseases and Related Health Problems, tenth version – Clinical Modification (ICD‑10‑CM), Current Procedural Terminology (CPT) codes and modifiers to determine accuracy based on current coding guidelines, regulatory requirements, and billing rules related to coding. This position provides education and training to CMG providers and staff related to professional coding and documentation.
Responsibilities
Completes annual initial coding reviews as assigned by the Manager of Professional Coding and Audit for Centra Medical Group (CMG) with a focus on Evaluation and Management.
Prepares individual provider Audit Summary reports based on review and shares findings per Centra’s CMG Coding Audit Plan Policy.
Maintains advanced knowledge and utilizes the current documentation guidelines for E/M services, ICD‑10‑CM, CPT, Healthcare Common Procedure Coding System (HCPCS) coding guidelines to apply best practices, conduct accurate audits and deliver feedback.
Maintains advanced knowledge and utilizes Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractor, Commercial payer, and other coding references (AMA, AAPC, CPT Assistant, etc.) guidelines related to coding to apply best practices, conduct accurate audits, and deliver feedback and education.
Facilitates education and training opportunities to Centra Medical Group (CMG) providers and staff related to professional coding and documentation (i.e. TEAMs instruction, small group and/or one‑on‑one setting).
Serves as an expert coding resource to Centra Medical Group (CMG) practices and responds to inquiries from providers and staff regarding proper coding/coding guidelines.
Research authoritative coding guidance related to complicated coding questions, new codes and/or new services to serve as an organizational subject matter expert on Evaluation and Management coding.
Other Functions
Contacts insurance companies and other health care organizations when necessary, regarding payer specific coding and documentation guidelines.
Assists with the development of education, training, and resources to be used for educating providers and staff to promote accurate coding.
May complete focus audits as needed and requested by the Manager of Professional Coding and Audit.
Reports coding concerns to the Professional Coding and Audit Manager and assists as needed in resolving issues.
Maintains strict confidentiality of all information including patient data, Healthcare information, financial/operational and employee/human resources.
Performs other duties as assigned.
Qualifications
Certified Professional Coder (CPC) or Certified Coding Specialists (CCS).
Minimum of 2 years working experience in Professional Evaluation and Management coding.
Must have working knowledge of Evaluation and Management documentation guidelines.
Must have working knowledge of Anatomy and Physiology.
Must have working knowledge of ICD‑10‑CM, Current Procedural Terminology (CPT) and HCPCS coding guidelines.
Must have exceptional communication skills including great listening skills, excellent written & verbal communication skills.
Must have demonstrated proficiency using Microsoft Word, Excel, and PowerPoint.
Seniority level Entry level
Employment type Full-time
Job function Accounting/Auditing and Finance
Industries Hospitals and Health Care
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Professional Coding and Audit Specialist independently performs audits of Centra Medical Group (CMG) provider documentation and coding of professional evaluation & management (E/M) services to include E/M, International Statistical Classification of Diseases and Related Health Problems, tenth version – Clinical Modification (ICD‑10‑CM), Current Procedural Terminology (CPT) codes and modifiers to determine accuracy based on current coding guidelines, regulatory requirements, and billing rules related to coding. This position provides education and training to CMG providers and staff related to professional coding and documentation.
Responsibilities
Completes annual initial coding reviews as assigned by the Manager of Professional Coding and Audit for Centra Medical Group (CMG) with a focus on Evaluation and Management.
Prepares individual provider Audit Summary reports based on review and shares findings per Centra’s CMG Coding Audit Plan Policy.
Maintains advanced knowledge and utilizes the current documentation guidelines for E/M services, ICD‑10‑CM, CPT, Healthcare Common Procedure Coding System (HCPCS) coding guidelines to apply best practices, conduct accurate audits and deliver feedback.
Maintains advanced knowledge and utilizes Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractor, Commercial payer, and other coding references (AMA, AAPC, CPT Assistant, etc.) guidelines related to coding to apply best practices, conduct accurate audits, and deliver feedback and education.
Facilitates education and training opportunities to Centra Medical Group (CMG) providers and staff related to professional coding and documentation (i.e. TEAMs instruction, small group and/or one‑on‑one setting).
Serves as an expert coding resource to Centra Medical Group (CMG) practices and responds to inquiries from providers and staff regarding proper coding/coding guidelines.
Research authoritative coding guidance related to complicated coding questions, new codes and/or new services to serve as an organizational subject matter expert on Evaluation and Management coding.
Other Functions
Contacts insurance companies and other health care organizations when necessary, regarding payer specific coding and documentation guidelines.
Assists with the development of education, training, and resources to be used for educating providers and staff to promote accurate coding.
May complete focus audits as needed and requested by the Manager of Professional Coding and Audit.
Reports coding concerns to the Professional Coding and Audit Manager and assists as needed in resolving issues.
Maintains strict confidentiality of all information including patient data, Healthcare information, financial/operational and employee/human resources.
Performs other duties as assigned.
Qualifications
Certified Professional Coder (CPC) or Certified Coding Specialists (CCS).
Minimum of 2 years working experience in Professional Evaluation and Management coding.
Must have working knowledge of Evaluation and Management documentation guidelines.
Must have working knowledge of Anatomy and Physiology.
Must have working knowledge of ICD‑10‑CM, Current Procedural Terminology (CPT) and HCPCS coding guidelines.
Must have exceptional communication skills including great listening skills, excellent written & verbal communication skills.
Must have demonstrated proficiency using Microsoft Word, Excel, and PowerPoint.
Seniority level Entry level
Employment type Full-time
Job function Accounting/Auditing and Finance
Industries Hospitals and Health Care
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