CODING AUDITOR – PROFESSIONAL SERVICES
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
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
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
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
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
License, Registration, or Certification
Certified Professional Coder (CPC) at the time of
Certified Professional Medical Auditor (CPMA) within
one (1) year of appointment
Department: Corporate Compliance
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