Nuvance Health

Nuvance Health.

  • Danbury, CT


  • Irreversible.

  • Full-time.

Job Description:

Nuvance Health has a network of practical medical facility and outpatient places– 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 numerous main and specialized care doctor practices places, consisting of The Heart Center, a leading service provider of cardiology care, and 2 immediate care workplaces. Non-acute care is provided through different affiliates, consisting of the Thompson House for rehab and competent nursing services, and the Home Care companies.

Summary:

Compliance Professional Coding Auditor– Professional Services

  • Reporting to the Special Associate Compliance Officer (SACO) Physician Audit & Billing, the Compliance Professional Coding Auditor offers clinician practice coding, billing, and documents auditing and education to the NUVANCE HEALTH MEDICAL PRACTICE.
  • Working understanding needed for this position is innovative competence in concerns to medical terms, anatomy, physiology, documents, coding standards, state and federal policies. Efficiently deals with all organization systems and offers suggestions towards constant enhancement of coding compliance and coding rejection management while making sure compliance with NUVANCE HEALTH MEDICAL PRACTICE (NHMP) policies along with all coding, Federal, State, and third-party payer standards.
  • Conducts expert coding audits and offers curricula and suggestions to doctor practice coding and billing personnel, doctors, advanced specialist specialists (APPs), and other clinicians, under the instructions of the SACO, or the Senior Compliance Officer (SCO) Quality, Clinical and Physician Audit, and Billing Cycle Integrity based upon audit outcomes.
  • Effectively utilizes abstracting databases, internal and external audit outcomes, and earnings cycle edit/denial info to determine problems or dangers.

Responsibilities:

  • Under the management of the SACO, perform a high volume of coding compliance audits throughout all NHMP in accordance with the Department Work Plan and other audits determined by Compliance Management; Reviews paperwork and coding to make sure compliance with all Federal and State standards. Integrate all expert health care services consisting of doctor, non-physician specialist, and allied health expert services of Nuvance Health into audit activity. Keep privacy of safeguarded health info and other types of secret information as needed under (i) suitable Federal and State law consisting of, without constraint, HIPAA and New York and Connecticut client and personal/private details privacy laws, respectively; and (ii) Nuvance Health policies and treatments. Preserve privacy of all details consisting of client scientific and group info, in addition to Nuvance monetary and functional information.
  • Maintain current records of all department audit and education activity databases on weekly basis in accordance with the department procedure.
  • Under the management of the SACO or SCO, conduct in-services and education as required.
  • Under the assistance of the SACO conduct proper specific education sessions for doctors, NPPs, and other clinicians offering expert services for NHMP in accordance with the department education work strategy. Strengthen appropriate coding, documents, and billing constant with NHMP policies, State and Federal regulative and compensation standards, keeping compliance while enhancing suitable earnings chances.
  • Communicate basic coding and billing guidelines and policies, i.e., Center for Medicare & Medicaid Services (CMS), American Medical Association (AMA), American Health Information Management Association (AHIMA), to guarantee proper Current Procedural Terminology (CPT), ICD-9-Clinical Modification (CM), ICD-10- Clinical Modification (CM), Healthcare Common treatment Coding System (HCPCS) and ICD-10- Procedural Classification System (PCS) coding for the Network’s expert services billed by NHMP clinicians. Stay present with modifications to CPT, HCPCS & ICD-10 coding systems, code updates
  • Assist SACO and/or SCO with coordination and management of all federal government audits for expert services consisting of, Medicare, Medicaid, Recovery Audit Contractor (RAC), Target Probe & Educate (TPE), Comprehensive Error Rate Testing (CERT), and so on, and third-party payer business audits for NHMP. Coordinate getting medical records and other information, validate efficiency of records prior to submission; conduct evaluation of medical records paperwork, coding, and billing as needed; guarantee prompt reaction to all audit demands within designated timeframes. Compose appeal letters as proper. Help with keeping third-party audit tracking software application.
  • Under the assistance of the SACO remain existing with all coding, Federal and State Coding, documents, and billing standards and policies, consisting of the OIG Work Plan products launched each month.
  • Collaborate with the NHMP coders to recognize mistakes, patterns, patterns, and variations in paperwork and coding practices. File findings using market compliance requirements, and report patterns or issues to SACO or SCO. Supply suggestions and feedback to SACO or SCO to enhance and enhance certified coding, billing, or paperwork practices. React to all questions in an expert and prompt way.
  • Deliver support to designated practices and to the Corporate Compliance Department in dealing with coding and billing concerns/questions, referring patterns, or issues to SACO or SCO. React to all queries in an expert, prompt way.
  • Support the Senior Compliance Officer (SCO) Quality, Clinical and Physician Audit, and Billing Cycle Integrity as asked for.
  • This position needs periodic travel to numerous Nuvance Health practices and entity areas.
  • Fulfills all other compliance obligations connected to the position.
  • Performs other tasks as appointed and in assistance of the SACO, SCO, and the Nuvance Health Compliance Program.
  • Maintain and Model Nuvance Health Values.
  • Demonstrates routine, trustworthy, and foreseeable participation.
  • Performs other tasks as needed.

Other info:

· Desired (not req ‘d): Knowledge of network paperwork and billing systems chosen.

Location: The Summit, Danbury, Ct

Work Type: Full-Time

Standard Hours: 40.00

FTE: 1.000000

Work Schedule: Day 8

Work Shift: 8: 00 am – 4: 30 PM

Org Unit: 239

Department: Corporate Compliance

Exempt: Yes

Grade: S7

Working conditions:

Essential:

  • Some manual skills/motor coord & finger mastery
  • Little or no capacity for occupational danger
  • Sedentary/light effort. Might put in as much as 10 pounds. force
  • Generally enjoyable working conditions.

EOE, consisting of disability/vets.

We will strive to make an affordable lodging to the recognized physical or psychological constraints of a certified candidate with an impairment unless the lodging would enforce an unnecessary challenge on the operation of our organization. If you think you need such help to finish this type or to take part in an interview, please contact Human Resources at 203-739-7330(for affordable lodging demands just). Please offer all details asked for to guarantee that you are thought about for existing or future chances.

Nuvance Health.

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