Location Address: Virtual

Top Reasons To Work At AdventHealth Corporate

• Great benefits
• Immediate Health Insurance Coverage
• Career growth and advancement potential

Work Hours/Shift:

• Full-Time, Monday – Friday

You Will Be Responsible For:

• Interprets and reviews medical record documentation to make sure the accurate ICD-10, CPT, HCPCS and assigned based on provider documentation.
• Expertise in auditing using both the 1995 and 1997 E/M CMS Guidelines
• Provides education to providers, practice staff, and coders as needed based on audit results.
• Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II and CMS guidelines.
• Demonstrate expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem solving skills.
• Maintains an accuracy rate of 90% or above for all work Quality Assurance reviews.
• Complete assigned work in a timely manner and maintain departmental production standards.
• Maintain open communication with Auditing Team and Auditing Supervisor.
• Critical thinking and problem solving skills are essential along with the ability to work independently, remotely and with minimal supervision. Must be self-motivated and able to use electronic resources.
• Other duties as assigned.

What You Will Need:

• High School Diploma or equivalent required.
• 3 or more years of experience in physician based coding for both E&M (outpatient/inpatient) and surgical procedures.
• At least one year of certified auditing experience.
• Knowledge of ICD-10, CPT, and HCPCS coding, along with modifiers for outpatient and inpatient procedures.
• Expertise in auditing using both the 1995 and 1997 E/M CMS Guidelines
• Knowledge of NCCI, MU, MUE edits and bundling guidelines.
• Knowledgeable with Microsoft software.

At least one of the following coding certifications:

• Certified Professional Coder (CPC)
• Certified Coding Specialist – Physician (CCS-P)
• Certified Professional Medical Auditor (CPMA)

Job Summary:

The Physician Enterprise Auditor is responsible for reviewing medical record documentation making sure that the CPT, ICD-10 and HCPCS codes and modifiers are correct for the selected claims.  The Auditor will follow AHS policy and procedure for annual audit schedules for both physicians and practices. The Auditor is responsible for completing professional reports of their findings and delivering those results to physicians and leadership.