Job description

Personalized Health Partners is currently recruiting Nurse Practitioner Coding Auditors. These positions can be mostly remote.

The PHP Nurse Practitioner Coding Auditor has a passion for inspecting medical documentation for clinical and coding accuracy. The nurse practitioner coding auditor will review documentation of PHP providers for accuracy and provide feedback to clinical leadership and education to providers based on audit findings.

Job Summary

The primary role of the Nurse Practitioner Coding Auditor is to review and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the medical record completed by Personalized Health Partner clinical providers. In addition, this role will be responsible for understanding the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) and communicating audit findings with the providers so that optimal accuracy can be assured. The responsibilities of the auditor in this role will be, but not limited to:

Reviews medical records within required timelines to determine completion and compliance with CMS and coding best practices
Reviews and assesses the accuracy, completeness, specificity, and appropriateness of diagnosis codes identified in the medical record
Communicates timely and effectively with the coding leadership and the clinical team regarding issues or corrections with the medical record
Understands the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding
Demonstrates a commitment to integrating coding compliance standards into coding practices
Identifies, corrects, and reports coding problems
Maintains adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare risk adjustment
Makes recommendations for coding policy/changes
Follows all legal and policy requirements for HIPAA protected data
Actively demonstrates teamwork at all times
Strong familiarity with the Coding Clinic
Expert level understanding of coding guidelines and is able to use and apply appropriate judgement

Required

EDUCATION and QUALIFICATION:

Master of Science in Nursing, Doctor of Nursing Practice, or NP Certificate Program graduate
National certification of AANP or ANCC
Active, unrestricted state license/s
Ability to obtain licensure in additional states in service area as requested (telehealth providers required to be licensed in OH, IN, WV, MD, VA, PA)
Active DEA license
US work authorization
3+ years clinical experience as a Nurse or Nurse Practitioner in geriatric, adult, or family practice setting
Ability to work in a flexible environment and schedule
Passionate about providing healthcare to the senior and low-income populations

Preferred Qualifications

3+ years clinical experience as a Nurse Practitioner
3+ years of experience preferred with coding & auditing experience
Expertise and experience in ICD-10, risk adjustment/HCC, and CPT coding methodologies
Training or clinical experience in geriatrics
Experience or training working in a metrics, results driven healthcare model
Be open to professional development through training, obtaining certifications if necessary, and attending team meetings
Experience working in value-based care models
Training or experience in geriatric, assisted living, and/or skilled nursing setting
Experience working in a collaborative healthcare setting to drive positive outcomes and achieve goals
Training or experience in outpatient primary care setting

Job Skills

Must have strong oral and written communication skills
Must be detail oriented with an ability to work well both independently and in a team setting
Exhibit a customer service approach with teams and residents
Strong time management skills required. Must be able to prioritize and adhere to competing deadlines while achieving goals

Required profile