Professional Coding Auditor/Consultant

Job Details

Description

PYA is seeking a Professional Coding Auditor/Consultant to join its high-performing and privately-owned firm with a dynamic culture and a strong national reputation. This individual will support PYA’s Revenue Integrity Service Line in a quality assurance and project management role .

RESPONSIBILITIES:

• Responsible for the accurate quality assurance review of PYA coding audits, as well as coding auditing of complex services rendered by physician and non-physician practitioners using current coding guidelines, with attention to Medicare, medical necessity, and NCD/LCD requirements. Professional coding auditing expertise in multiple specialties is required, including strength in E/M and surgical coding, especially cardiology and orthopedic surgery. Expertise in facility inpatient and outpatient coding auditing is preferred but not required.
• The Consultant will assist PYA clients with provider documentation improvement, reviews for billing and other regulatory compliance with third party payers, revenue cycle management, as well as reimbursement methodology advisory support.

REQUIREMENTS:

• Current credential of CPC/CCS-P or related coding professional credential required
• Strong understanding of and experience in auditing for compliance with 1995, 1997, and 2021/2023 E/M Guidelines required
• Experience in surgical coding auditing is required (cardiology and orthopedic surgery is preferred)
• Additional credentials such as RHIT, CCS, CPMA, or specialty designations desirable
• Physician financial reimbursement and revenue cycle understanding is preferred
• Knowledge related to post-acute coding and billing (SNF, Home Health, Palliative Care, Behavioral Health) is a plus
• Experience presenting to physicians and other healthcare providers required
• Professional services firm experience desired
• Ability to work in a fast-paced, high-volume coding audit (5-7 encounters per hour average expected) environment with a team, which expects high-quality deliverables and accuracy to clients
• Superior communication skills, both oral and written
• Excellent project management skills
• Traits that include detail-oriented, flexible, and responsive

ABOUT PYA:

Serving clients in all 50 states from offices in seven cities, PYA is ranked by INSIDE Public Accounting as one of the nation’s Top 100 largest CPA firms, with the third-highest percentage of female ownership within that group. Forbes has recognized PYA one of America’s Best Tax and Accounting Firms for the last two years. Accounting Today has highlighted PYA as “One of the most successful firms in the country.” Modern Healthcare ranks PYA among the nation’s Top 20 healthcare consulting firms, and PYA is one of the Top 15 auditors of the nation’s largest health systems.

This success is the result of four decades of steadfast adherence to a culture of responsiveness, integrity and relationships—both with clients and colleagues—"The PYA Way.”