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

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, 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, 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.

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.

Summary:

Responsible for coding quality and audits, education and training, etc. for ICD-10-CM, CPT and HCPCS codes for Virtua Medical Group and Pro-Fee coding department.  Responsible for developing, implementing and maintaining compliance plan for provider coding and abstracting. 

Responsible for coding quality and audits, education and training.

Responsible for developing, implementing and maintaining compliance plan for VMG coding and abstracting.

Participates in system administration maintenance duties for coding and abstracting software.

Position Responsibilities:

Audits

• Designs audit tools to monitor coding and abstracting quality and compliance; performs audits; provides timely feedback to staff and providers; makes recommendations for improvement.

• Performs special audits to facilitate quality improvements and compliance (External Coding Audit Response: Conducts exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating coders and providers).

• Conducts meetings to discuss outcomes, reviews reports, works with physicians to provide appropriate clinical documentation, to ensure compliant assignment of codes.

• Responds to daily questions from coders and providers regarding correct application of coding guidelines to individual accounts.

Accounts Receivable

• Assists with monitoring of Discharge Not Final Billed reports, troubleshooting, resolving complex problems with individual accounts in order to facilitate appropriate reductions in A/R and accounts held for coding.

• Codes charts when urgently needed to facilitate A/R goals.

• Works closely with all areas to provide efficiencies in operational coding workflow, adjustment in workflow queues, etc.

Patient Accounting Resolution

• Works closely with Patient Accounting vendor to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements.

Policies and Procedures

• Develops policies and procedures on coding, data abstraction and Corporate Compliance.

• Documents and enforces policies and procedures for staff and providers and provides feedback to appropriate supervisors and/or staff.

• Recommends changes to policies, procedures, charge master and documentation requirements to insure appropriate reimbursement.

• Monitors and reports on productivity and quality standards.

Coding, abstracting and state data system maintenance

• Maintains and updates systems to collect accurate data for billing and state data collection as well as hospital statistical requirements.

• Identifies and resolves problems with the assistance of IS and vendor counterparts.

• Manages downtime and puts back up plans into place.

• Facilitates timely completion of state reporting by monitoring reports and taking action to resolve accounts in question.

Position Qualifications Required / Experience Required:
 

3 years Pro-Fee auditing and education experience required

General Pro-Fee coding experience required, multi-specialty preferred (cardiac, obstetrics, orthopedics, medical-surgical, etc.)

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

Knowledge of ICD-9, CPT-4, DRGs, APCs and CMI required.

Able to develop and present education presentations required.

Required Education:

Bachelor or Associates Degree in HIM, or Coding Certificate Program, or equivalent experience, leading to appropriate certification.

Training/Certifications/Licensure:

Certification as CPC by AAPC required, CPMA 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.