Description

**Fully remote opportunity within approved working states**

Summary:

Reporting to the Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Senior Inpatient Professional Auditor provides Hospital Inpatient and Outpatient coding, billing, and documentation auditing and education to the NUVANCE HEALTH network. Working knowledge required for this position is advanced expertise in regards to medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations. Works closely with all business units and provides recommendations toward continuing improvement of coding compliance and coding denial management, while ensuring compliance with NUVANCE HEALTH Hospital policies as well as all coding Federal, State, and third party payer guidelines. Conducts inpatient and/or outpatient coding audits and provides educational programs based on auditing results. Effectively uses abstracting databases, internal and external audit results, QIO reports and revenue cycle edit/denial information. Effectively interacts with, Revenue Integrity, Patient Financial Services, Coding Department(s) staff and different levels of management across the Nuvance Health network.

Responsibilities:

1. Under the leadership of the SACO, conducts high volume of coding compliance audits across all Nuvance Hospitals 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. Ensure correct DRG and APC assignments for Institutional claims.

2. Maintains 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.

3. Provides comprehensive guidance regarding proper coding and documentation practices consistent with Nuvance Health policies and best practices, and all coding, Federal and State regulatory, and reimbursement guidelines maintaining compliance.

4. Assists with development, updating, maintenance, and disseminating training and education materials to Nuvance Health clinicians, managers, and coding department staff. Provide material and conduct presentations for Compliance education programs as needed.

5. Communicates and reinforces proper documentation, coding and billing rules and regulations consistent with Nuvance Health policies, 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 Hospital Inpatient and Outpatient coders and services.

7. Performs independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations� practices/policies/guidelines to keep Nuvance Health current with regulatory requirements and accepted compliance and audit practices.

8. Collaborates with the Hospital Coding Department 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.

9. Records and tracks all DRG and APC compliance audits, assessments, and corrective action plans for Nuvance Health in the compliance tracking logs or vendor-provided databases in accordance with department procedures and audit activity processes. Document and capture timely updates until all corrective action plans are implemented and completed. Perform timely follow-up on outstanding compliance issues; ensure any required changes have occurred to coding, billing, documentation practices, and any associated policies or procedures.

10. Maintains and Models Nuvance Health values.

11. Demonstrates regular, reliable and predictable attendance.

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

Education: ASSOCIATE'S LVL DGRE

Other Information:

Manual: Some manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 1771

Department: Corporate Compliance

Exempt: Yes

Salary Range: $27.91 - $51.83 Hourly