Medical Auditor - Billing and Coding

Title: Medical Auditor (Billing and Coding)

Location: Lynchburg, Northern Virginia, Richmond, Southwest Virginia

Full time

Job Description:

At OrthoVirginia, you’re part of a team dedicated to delivering expert orthopedic and therapy care across the state. As Virginia’s largest provider of musculoskeletal care, we offer full-time and part-time opportunities in a collaborative, team-oriented environment.

With more than 159 physicians in over 35 locations—including Lynchburg, Northern Virginia, Richmond, Southwest Virginia, and Hampton Roads—OrthoVirginia is a leader in orthopedic surgery, non-surgical care, and physical, hand, and occupational therapy. Our nationally recognized specialists treat a full range of musculoskeletal injuries and conditions, helping patients of all ages move, heal, and thrive.

Join us and become part of a trusted network committed to excellence in orthopedic care.

Medical Auditor (Billing & Coding)

Previous coding experience required
Hybrid - must be able to travel by car to regional offices

Job Description 

Responsible for conducting coding and documentation audits for assigned providers and consulting and educating providers on documentation requirements and other compliance issues related to billing. 

Under the direct supervision of the Billing & Coding Compliance Manager, this full-time position will work with physicians and other clinicians to ensure they comply with documentation and coding standards, regulations and requirements. This includes conducting billing and coding audits, identifying and resolving issues, and educating clinicians and staff on requirements for documenting, coding and billing medical services. 

Job Responsibilities and Accountabilities: 

• Assists with monitoring of OrthoVirginia’s Compliance Program as related to billing, coding, and documentation, including the OIG Compliance Program guidance for physician practices and third-party billing companies 

• Performs audits of coding and billing data for accuracy and compliance with federal regulations 

• Conducts physician, APP, physical/occupational therapy and scribe coding and documentation education classes as needed/requested 

• Educate clinicians on documentation and coding requirements to ensure accurate coding level assignment and compliance, utilizing exceptional written and verbal communication skills through face-to-face interactions, email, written correspondence, and telephone communication. 

• Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through education, and other educational activities. 

• Meets with assigned providers on a regular basis to educate and review results of audits 

• Responsible for keeping up to date with all E/M and Therapy  Documentation Guidelines 

• Monitors all compliance issues identified during routine audits and recommends areas that indicate a focused audit may be necessary 

• Assists with projects as directed 

Qualified Candidates must meet all of the following criteria: 

• Exemplifies OrthoVirginia’s values – excellence, compassion and unity 

• Bachelor’s Degree or equivalent with 3+ years’ experience working as a credentialed coder, preferably in a medical practice 

• Licensing, certification/degree as one of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Evaluation and Management Coder (CEMC) required 

• Experience or familiarity with physical/occupational therapy billing and coding practices, documentation standards, and federal reimbursement and compliance guidelines would be a strong asset.  

• Thorough knowledge of CPT and ICD coding principles and guidelines 

• Knowledge of Medicare and Medicaid rules for documentation of billed services 

• Strong analytical and problem-solving skills required including experience auditing 

• Ability to exercise initiative, problem-solving and decision-making to effectively plan, prioritize, and complete projects/tasks with little supervision in a fast paced, changing environment 

• Specific, thorough understanding of regulatory requirements relating to documentation, claims processing, reimbursement, and coding 

• Skilled in establishing and maintaining effective professional working relationships with physicians, advanced practice providers, administration and team members 

• Advanced working experience in Microsoft Office including Excel (formulas, pivot tables, dashboards, etc) 

• Exceptional written and strong verbal communication skills: Meeting, presenting and corresponding with clinicians. 

Other: 

• Has access to and knowledge of extremely sensitive, private and confidential materials-ability to maintain the highest standard of confidentiality is required with zero tolerance 

• Participates in professional developments efforts to ensure currency in health care policies and trends 

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions 

• Some travel to regional offices will be required 

Compensation Range for this position:

$26.44 - $39.66

Compensation for this role will be based on several factors, including the candidate's qualifications, relevant experience, education, skills, certifications, geography/market, and internal equity considerations.