Lead VMG Coding Auditor & Educator

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Job Summary:

Responsible for leading professional fee (pro-fee) coding quality audits, education, and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes leading the workflow of the audit team performing internal audits and providing education and training to the pro-fee coders and clinicians. Responsible for leading all activities related to the large scale external audit, including creating and maintaining audit documentation, ensuring audit schedule and reporting meet required timelines, and coordinating post-audit activities (including provider education and re-audit). Works with Director to implement and execute on the compliance plan for VMG coding.

Position Responsibilities:

Leads and coordinates all phases of external clinical professional fee coding audit:

• Selects audit sample and applies national bell curve in system
• Communicates audit results to clinicians and leads
• Manages rebuttals
• Coordinates and performs post audit education
• Coordinates and performs re-audits
• Tracks and reports results
• Ensures phase schedule of audits and post-audit follow up is tracked and maintained.
• Maintains all audit documentation and serve as a liaison for internal and external auditors

Lead and coordinate internal coder professional fee audit:

• Selects audit sample
• Assigns auditors as needed
• Tracks progress and results
• Communicates results to Coding Operations Managers

Leads workflow for the audit and education team who provide training and education for all internal coders, Leads confirmation audit planning for all internal coders once they 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.). Serves as an escalation point to the education and audit team when responding External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders). to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines.

Coordinates workflow of staff performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director. . Performs chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit. Reviews work queue edits for provider coding trends and education needs. Confidently educates clinicians based on chart audit and coding trends.

Assists in implementation and maintenance of audit software system. Utilizes software for all audit activities and recommends changes and customization. Maintains Epic records for semi-compliant and non-compliant providers to ensure enhanced review levels are supported within the Epic work queues.

Assigns audit and education team members to works closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements. Provides education to their staff, including clinicians and billers on pro-fee coding issues. Recommends changes to workflows to ensure appropriate documentation and reimbursement.

Develops policies and procedures on coding, data abstraction and compliance for VMG. Documents and enforces policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff. Recommends changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement. Assists Coding Director with monitoring and reporting on productivity and quality standards.

Position Qualifications Required:

Required Experience:

3+ years professional fee(provider) coding and healthcare auditing experience required.

Professional fee auditing and education experience required.

Multi-specialty professional fee coding experience preferred

Advanced organizational skills - ability to work proactively with multiple priorities

High level of technical proficiency in Word, Excel, PowerPoint, Outlook, EMR systems

Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required

Ability to develop and present education presentations required

Required Education:

Coding Certificate Program, or equivalent experience, leading to appropriate certification

Training / Certification / Licensure:

CPC Certification by AAPC required

CPMA Certification by AAPC preferred

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