Sr Professional Facility Auditor

Senior Professional Facility Auditor

Nuvance Health is seeking a detail-oriented and experienced Senior Professional Facility Auditor to join our Facility Charging and Coding team. In this role, you will perform in-depth audits of facility and professional coding to ensure clinical documentation supports services rendered. Your expertise in medical terminology, anatomy, physiology, regulatory compliance, and coding guidelines will be essential in driving accuracy and improving documentation and billing practices across our organization.

Key responsibilities include conducting comprehensive audits of ICD-10, CPT4, HCPCS, E/M codes, medical supplies, orders, and UB04/revenue codes for both facility and professional services. You will lead educational sessions for coders based on audit findings to reinforce compliance with CMS, Medicare, state/federal regulations, and internal policies. Staying current with CMS, NGS Medicare, AAPC, and OIG updates, bulletins, and compliance requirements to ensure up-to-date coding standards is also essential. Collaborating with physician and hospital coding leadership to identify documentation and coding trends, errors, and improvement opportunities is part of your role. Performing accurate coding and charging for complex clinical services, including interventional cardiology, radiology, and vascular procedures, utilizing internal systems and applications with a high level of competency to ensure audit accuracy and reporting efficiency, participating in team meetings, ongoing education, and continuous improvement initiatives to support departmental goals, maintaining high standards for customer service, teamwork, safety, and compliance, and performing additional duties as assigned are also part of your responsibilities.

Required qualifications include CPC, CCS-P, COC, RHIT – With Coding/Auditing experience, RHIA – With Coding/Auditing experience, outpatient facility coding - auditing will include facility coding for interventional radiology, cardiac cath, outpatient surgery, observation, & ancillary, advanced knowledge of medical terminology, anatomy, physiology, and federal/state documentation and billing regulations, extensive experience auditing both facility and professional medical coding, and proficiency in coding complex encounters and using relevant coding systems and software. Preferred qualifications include an associate's degree or higher, CIRCC & CCC, and coursework in anatomy and physiology.