Job Description
Audit
To conduct compliance reviews of the coding and documentation of procedural and diagnosis coding, billing and medical record documentation performed by Nemours clinical services providers (physicians and billing providers) as well as coding and billing associates, as requested by the Coding Integrity Director. The coding auditor will also meet with clinical services providers to discuss their compliance reviews and present continuing education, as necessary. This position will also work on special projects individually or in collaboration with other coding auditors, as requested, including providing training and education to Nemours clinical services providers, coding and billing associates on coding and billing rules and regulations.
Essential Responsibilities:

1. Conduct compliance reviews of procedural and diagnosis coding, billing and medical record documentation performed by clinical services providers and coding and billing associates at all Nemours sites, or as requested by the Coding Integrity Director.
2. Prepare reports as required relative to monitoring and review activities.

3. Conduct post-review meetings with clinical services providers and coding/billing associates.
4. Conduct education sessions for clinical services providers and coding and billing associates on coding and billing regulations.
5. Work closely with coding and billing associates at all sites to assure compliance with Nemours on coding, billing, monitoring and review activities.
6. Assist in the development of Nemours policies, and monitoring and review activities as required.
7. Participate in planning sessions with the Coding Integrity Director to develop clinical services provider coding review schedule based on clinical service providers' historical coding accuracy and organizational needs
8. Assist the Coding Integrity Director in the development of an annual work plan for coding monitoring, education, and improvement, including the establishment of measurable success criteria.
9. Monitor and communicate additions and/or revisions to coding and documentation rules, regulations. Assist in development of system-wide coding and billing policies, as requested.
10. Coordinates effectively with Nemours Compliance and Internal Audit Services staff as required.
11. Periodically monitor and report on the coding interfaces associated with the Nemours Electronic Medical Record (Epic).
Position Qualifications:

1. High School diploma required, Associate Degree preferred

2. Must be a certified professional coder with either the AAPC or AHIMA
3. Minimum five years hands-on experience in physician coding
4. Thorough knowledge of CMS' coding and documentation guidelines
5. Knowledge of third party physician service billing practices and systems (commercial and governmental)
Licenses, Registrations, Certifications:

• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) certification is required.
• Attending conferences, webinars, and local chapter meetings to maintain continuing education units in order to stay certified.

About Us
As one of the nation's premier pediatric health care systems, we've made a promise to do whatever it takes to prevent and treat even the most disabling childhood conditions. It's a promise that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention.
Equity, diversity, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive environment. All Nemours Associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.
Nemours aspires to have its workforce and providers reflect the rich diversity of the communities we serve. Candidates of diverse backgrounds, race and ethnicity, religion, age, gender, sexual orientation, and those committed to working with diverse populations and conversant in multicultural values are strongly encouraged to apply. Please click here to review Nemours Anti-Racism Statement (nemours.org).
To learn more about Nemours and our commitment to treat every child as if they were our own, visit us at www.nemours.org.