Coding and Compliance Internal Auditor I CPC

Job description

Responsible for coding quality audits of all records (outpatient, inpatient, procedures, testing) to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers and staff; also responsible for assisting with coding inquiries from providers, charge posters, billing staff, etc.

Principal Accountabilities:

Coordinates, schedules, performs the professional services documentation and coding audits of outpatient, inpatient, procedures and testing records for physician practices.




+ Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported

+ Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines

+ Responsible for maintaining up to date knowledge of coding guidelines as they relate to professional services.

+ Develop and coordinate educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates.

+ Evaluates and provides appropriate documentation for the third party payer CPT denials to maintain the original CPT assignment, and when necessary, implement corrective action plan and/or educational programs to prevent similar denials and rejections from recurring.

+ Meets with the providers to review the audit findings and to recommend ways to improve when indicated

+ Orients and trains new providers throughout the year

+ Audit charts for accurate and correct coding and compliance within documentation guidelines and AHS policies

+ Prepares written reports of the audit findings by provider/practice

+ Follows up with providers as needed until documentation improves

+ Assists with claim denial reports to ensure optimal reimbursement

+ Serves as a resource to the office staff, providers, and billing department

+ Provides clarification on coding and compliance policies


Required:
• CPC Certification
• Minimum 6 months experience in similar role highly preferred
• High School Diploma, College a plus
• Work Experience in the business of healthcare which includes: Medical Terminology and Coding and billing experience


#LI-AW1


At Atlantic Health System, our promise to our communities is; Anyone who enters one of our facilities, will receive the highest quality care delivered at the right time, at the right place, and at the right cost.

This commitment is also echoed in the respect, development and opportunities we give to our more than 20,000 team members.

Headquartered in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation.

Our facilities and sites of care include:




+ Morristown Medical Center, Morristown, NJ

+ Overlook Medical Center, Summit, NJ

+ Newton Medical Center, Newton, NJ

+ Chilton Medical Center, Pompton Plains, NJ

+ Hackettstown Medical Center, Hackettstown, NJ

+ Goryeb Children's Hospital, Morristown, NJ

+ CentraState Healthcare System, Freehold, NJ

+ Atlantic Home Care and Hospice

+ Atlantic Mobile Health

+ Atlantic Rehabilitation




We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group.

Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of AllSpire Health Partners.

We have received awards and recognition for the services we have provided to our patients, team members and communities.

Below are just a few of our accolades:




+ 100 Best Companies to Work For ® and FORTUNE® magazine for 15 years

+ Best Places to Work in Healthcare - Modern Healthcare

+ 150 Top Places to work in Healthcare - Becker's Healthcare

+ 100 Accountable Care Organizations to Know - Becker's Hospital Review

+ Best Employers for Workers over 50 - AARP

+ Gold-Level Well Workplace: Wellness Council of America (WELCOA)

+ One of the 100 Best Workplaces for “Millennials” Great Place to Work® and FORTUNE® magazine

+ One of the 20 Best Workplaces in Health Care: Great Place to Work® and FORTUNE® magazine

+ Official Health Care Partner of the New York Jets

+ NJ Sustainable Business






Atlantic Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members.

Offerings vary based on role level (Team Member, Director, Executive).

Below is a general summary, with role-specific enhancements highlighted:



Team Member Benefits



+ Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members)

+ Life & AD&D Insurance.

+ Short-Term and Long-Term Disability (with options to supplement)

+ 403(b) Retirement Plan: Employer match, additional non-elective contribution

+ PTO & Paid Sick Leave

+ Tuition Assistance, Advancement & Academic Advising

+ Parental, Adoption, Surrogacy Leave

+ Backup and On-Site Childcare

+ Well-Being Rewards

+ Employee Assistance Program (EAP)

+ Fertility Benefits, Healthy Pregnancy Program

+ Flexible Spending & Commuter Accounts

+ Pet, Home & Auto, Identity Theft and Legal Insurance


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Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits.

Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer.




EEO STATEMENT




Atlantic Health System, Inc.

is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.

Required Skill Profession

Other General