Profee Clinical Data Quality Admin (CDQA) / Coding Auditor / Coding Educator for Virtua Medical Group CPC (Remote)

Job description

At Virtua Health, we exist for one reason – to better serve you.

That means being here for you in all the moments that matter, striving each day to connect you to the care you need.

Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between – we are your partner in health devoted to building a healthier community.

If you live or work in South Jersey, exceptional care is all around.

Our medical and surgical experts are among the best in the country.

We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home.

A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations (https://www.virtua.org/locations) , we're committed to the well-being of the community.

That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program (https://www.virtua.org/about/eat-well) , telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling.

We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.


Location:
100% Remote


Currently Virtua welcomes candidates for 100% remote positions from: AZ, CT, DE, FL, GA, ID, KY, MD, MO, NC, NH, NJ, NY, PA, SC, TN, TX, VA, WI, WV only.
Remote Type:
100% Remote

Employment Type:
Employee

Employment Classification:
Regular

Time Type:
Full time

Work Shift:
1st Shift (United States of America)

Total Weekly Hours:
40
Additional Locations:



Job Information:
* The shift schedule is anywhere between 7am- 7pm depending on meetings with clinicians.





Job Summary:

Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc.

for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department.

This includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders.

Responsible for working with VMG practices to resolve all coding issues that prevent accounts from being processed appropriately.

Responsible for developing, implementing and maintaining compliance plan for pro-fee coding and abstracting.



Position Responsibilities:

Training and Education:


Providing training and education for newly hired coders that includes utilizing the medical record in conjunction with rules and regulations to properly code VMG encounters.

Audits new coders once they approved to submit charges in the work queues and provides appropriate feedback.

Developing coding and training resources for the entire coding team (modules, scenarios, tip sheets, etc.).

External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders).

Responds to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts.

Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines.


Auditing:


Performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director.

Overseeing the annual external audit process for all clinicians that bill under the VMG TIN by creating audit samples, communicating results to clinicians and providing annual coding education.

Performing chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit.

Reviewing work queue edits for provider coding trends and education needs.

Confidently educates clinicians based on chart audit and coding trends.




Accounts Receivable:


Assisting with monitoring of pre-AR aging reports.

Troubleshooting and resolving complex problems with individual accounts in order to facilitate appropriate reductions in A/R and accounts held for coding.

Coding charts when urgently needed to facilitate A/R goals.

Working closely with Practice Directors and Practice Managers to provide efficiencies in operational workflows related to clinician coding.


Review and Resolution of Interdepartmental Coding-related Issues:


Working closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements.

Providing education to their staff, including clinicians and billers on pro-fee coding issues.

Recommending changes to workflows to insure appropriate documentation and reimbursement.


Policies and Procedures:


Developing policies and procedures on coding, data abstraction and compliance for VMG.

Documenting and enforcing policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff.

Recommending changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement.

Monitoring and reporting on productivity and quality standards.


Position Qualifications Required / Experience Required:

3 years professional fee (provider) coding or a combination of 3 years professional fee (provider) coding and healthcare auditing experience required


Professional fee auditing and education experience preferred


Multi-specialty professional fee coding experience preferred


Knowledge of PC database applications, Microsoft Office, spreadsheet design, encoder required


Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required


Ability to develop and present education presentations required

Required Education:Coding Certificate Program, or equivalent experience, leading to appropriate certification Training/Certifications/Licensure:

CPC Certification by AAPC required


CPMA Certification by AAPC preferred


Annual Salary: $65,000 - $103,758
The actual salary/rate will vary based on applicant’s experience as well as internal equity and alignment with market data.


Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions.

Eligibility for benefits is governed by the applicable plan documents and policies.

For more benefits information click here (http://view.publitas.com/kelly-1/virtua-benefit-guide-pt-2025/) .

Required Skill Profession

Other General