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Compliance Professional Coding Auditor Job in Danbury, Connecticut

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Job Title: Compliance Professional Coding Auditor

Employer:Nuvance Health
Job Location:Partial Remote
Skills:Coding and auditing
Required Certifications:CPC
Preferred Certifications:CPMA
Required Experience:3 to 4 years
Preferred Experience:3 to 4 years
Location: Danbury 06810, CT, US
Date Posted:11/3/2021



Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center, and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices.  Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.


Reporting to the Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Compliance Professional Coding Auditor provides clinician practice coding, billing, and documentation auditing and education to the NUVANCE HEALTH MEDICAL PRACTICE. Working knowledge required for this position is advanced expertise in regard to medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations. Effectively works with all business units and provides recommendations toward continuing improvement of coding compliance and coding denial management while ensuring compliance with NUVANCE HEALTH MEDICAL PRACTICE (NHMP) policies as well as all coding, Federal, State, and third-party payer guidelines. Conducts professional coding audits and provides educational programs and recommendations to physician practice coding and billing staff, physicians, advanced practitioner professionals (APPs) and other clinicians, under the direction of the SACO, or the Senior Compliance Officer (SCO) Quality, Clinical and Physician Audit, and Billing Cycle Integrity based on audit results. Effectively uses abstracting databases, internal and external audit results, and revenue cycle edit/denial information to identify issues or risks.

Essential Responsibilities:

1.       Under the leadership of the SACO, conduct high volume of coding compliance audits across all NHMP in accordance with the Department Work Plan and other audits identified by Compliance Management; Reviews documentation and coding to ensure compliance with all Federal and State guidelines. Incorporate all professional healthcare services including physician, non-physician practitioner, and allied health professional services of Nuvance Health into audit activity. Maintain confidentiality of protected health information and other forms of confidential information as required under: (i) applicable Federal and State law including, without limitation, HIPAA and New York and Connecticut patient and personal/private information confidentiality laws, respectively; and (ii) Nuvance Health policies and procedures. Maintain confidentiality of all information including patient clinical and demographic information, as well as Nuvance financial and operational data.

2.       Maintain up to date records of all department audit and education activity databases on weekly basis in accordance with the department process.  Under the leadership of the SACO or SCO, conduct in-services and education as needed. 

3.       Under the guidance of the SACO conduct appropriate individual education sessions for physicians, NPPs and other clinicians providing professional services for NHMP in accordance with the department education work plan.  Reinforce proper coding, documentation and billing consistent with NHMP policies, State and Federal regulatory and reimbursement guidelines, maintaining compliance while optimizing appropriate revenue opportunities.

4.       Communicate standard coding  and billing rules and regulations, i.e., Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), to ensure appropriate Current Procedural Terminology (CPT), ICD-9-Clinical Modification (CM), ICD-10-Clinical Modification (CM), Healthcare Common procedure Coding System (HCPCS) and ICD-10-Procedural Classification System (PCS) coding for the Network's professional services billed by NHMP clinicians. Stay current with changes to CPT, HCPCS & ICD-10 coding systems, code updates

5.       Assist SACO and/or SCO with coordination and management of all government audits for professional services including, Medicare, Medicaid, Recovery Audit Contractor (RAC), Target Probe & Educate (TPE), Comprehensive Error Rate Testing (CERT) etc., and third party payer commercial audits for NHMP. Coordinate obtaining medical records and other data, verify completeness of records before submission; conduct review of medical records documentation, coding and billing as required; ensure timely response to all audit requests within designated timeframes. Write appeal letters as appropriate. Assist with maintaining third party audit tracking software.

6.       Under the guidance of the SACO stay current with all coding, Federal and State Coding, documentation and billing guidelines and regulation’s, including the OIG Work Plan items released every month.

7.       Collaborate with the NHMP coders to identify errors, patterns, trends and variances in documentation and coding practices.  Document findings utilizing industry compliance standards, and report patterns or concerns to SACO or SCO. Provide recommendations and feedback to SACO or SCO to improve and optimize compliant coding, billing or documentation practices.  Respond to all inquiries in a professional and timely manner. 

8.       Deliver assistance to assigned practices and to Corporate Compliance Department in addressing coding and billing concerns/questions, referring patterns or concerns to SACO or SCO. Respond to all inquiries in a professional, timely manner.

9.       Support the Senior Compliance Officer (SCO) Quality, Clinical and Physician Audit, and Billing Cycle Integrity as requested.

10.   This position requires occasional travel to various Nuvance Health practices and entity locations.

11.   Fulfills all other compliance responsibilities related to the position.

12.   Performs other duties as assigned and in support of the SACO, SCO, and the Nuvance Health Compliance Program.

13.   Maintain and Model Nuvance Health Values.

14.   Demonstrates regular, reliable and predictable attendance.

15.   Performs other duties as required.

Education and Experience Requirements:

                     This position requires a minimum formal education of High School Diploma required and three + year’s job-related experience in a Compliance Auditing position.

                     Associate degree preferred.

                     Multiple specialty coding experience.

Minimum Knowledge, Skills and Abilities Requirements:

                     Must possess a strong body of knowledge in relation to anatomy physiology, medical terminology and the disease process to be adept in analyzing and assessing medical records, billing records, and other confidential protected health information as necessary to perform compliance duties, function and role. 

                     Proficient skills with Word, Excel, PowerPoint and coding software. Proficient Presentation and education experience.

                     Coding experience preferred

                     Knowledge of network documentation and billing systems preferred.


License, Registration, or Certification Requirements:

         Certified Professional Coder (CPC) at the time of appointment

         Certified Professional Medical Auditor (CPMA) within one (1) year of appointment


Department:               Corporate Compliance

FLSA Status:                 Exempt





EOE, including disability/vets.


We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.


Nancy Yi
Talent Acquisition Partner
Nuvance Health HR

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