Regulatory Services Coding Auditor chez Physicians East, P.A.

Job Title: Regulatory Services Coding Auditor

 About us

Physicians East, P.A.is a team of skilled healthcare professionals united to meet the challenge of delivering quality, cost-efficient, comprehensive healthcare to the people of Eastern North Carolina.

 About the role

We are looking for an employee that can work in a fast-paced office setting to conduct in-house audits, provider education, and provide coding related support to expedite the billing process. Additionally, proactively appeals, and assists with rebilling of claims addressing identified errors. Predominantly remote position with periodic travel to Physician’s East locations to deliver audit findings and conduct provider education.   A period of training will be required on site.  Applicant must be located in North Carolina.

 Supervision Received: Reports to Regulatory Services Manager.

 Supervision Exercised: Limited.

 Typical Physical Demands: Requires prolonged standing or sitting while working in an work environment.  Requires some bending or stretching.  Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment.

Typical Working Conditions:

Hybrid – Onsite and Remote with 30% travel

Responsibilities

• Reviews patients’ medical records to ensure coding levels and charting meets standards and regulations
• Capable of performing retro audits on patients’ account to ensure documentation supported the level of Evaluation and Management charged
• Completes analysis, charts, and spreadsheets to present outcomes to management and physicians
• Educates physicians and employees on compliance audit findings by specialty after routine audits or when problems are identified
• Responsible for being up-to-date and knowledgeable of coding process and diagnostic procedures as well as carrier specific policies, guidelines, and updates 
• Research contract allowable to ensure proper payment as well as remaining current about federal and state legislative changes that affect outcomes
• Share information as necessary with the Coding & Insurance departments
• Stay informed of updates on payer websites
• Communicate with Coding and Insurance Supervisors regarding denial trends, problematic denials, and reimbursement issues
• Inform Regulatory Services Manager of CPT codes that are routinely not paid, repetitive noncovered diagnoses, or codes not paying according to contractual fee schedules
• Reports all identified compliance audit issues to Regulatory Services Manager
• Assist Coding and Insurance departments with third party payer coding rules and regulation questions
• Provide coding related support to the Coding and Insurance departments for follow-up to expedite appeals and rebilling of claims.   This will include researching and correcting claims to validate denial adjustments
• Communicates closely with the Insurance Department Medicare Team to ensure that secondary claims are not held up due to coding issues
• Provide other assistance to the Coding or Insurance Department as directed by the Regulatory Services Manager 
• Maintains patient confidentiality
• Ability to work independently and proficiently in a remote office environment
• Attends meetings when required (onsite/remote)

Location & Schedule Commitments

• Permanent full-time role based out of our Greenville Arlington Blvd. location, Monday-Friday, 8a.m. – 5 p.m.
• Candidate will work remotely upon training with 30% travel required.
• Flexible schedule.
• Applicant must be located in North Carolina

Candidate requirements

• Associate degree or bachelor’s degree in health information management with RHIT/RHIA certification and 3-5 years of multi-specialty ICD-10 and CPT experience, or bachelor’s degree in health care related field with CPC/CCS-P/CPMA certification and 2-4 years of direct ICD-10 and CPT experience, or CPC/CCS-P/CPMA certification with 4-6 years of multi-specialty ICD-10 and CPT experience. 

Affirmative Action/EEO statement

Physicians East, P.A.is an equal opportunity employer and will not discriminate against any applicant or employee on the basis of age, race, color, ethnicity, religion, creed, sex (including gender, pregnancy, sexual orientation, and gender identity, which includes status as a transgender individual), national origin or ancestry, citizenship, past, current, or prospective service in the uniformed services, genetic information (including family medical history), physical or mental disability, or other legally protected status. Reasonable accommodation will be made for persons with disabilities during the application process and/or at the time of employment. Requests for accommodation should be made to the Human Resources Department as early as possible in the application/employment process.