Professional Coding Auditor/Consultant

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 team in a professional coding auditor role.

RESPONSIBILITIES:

• Responsible for the accurate review of PYA clients’professional fee coding per industry coding audit standards, support of the management team with project management tasks, support of the verbal and written reporting to the client, and conducting provider coding and documentation education (generally, conducted remotely).
• 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, preferably including 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 coding and documentation improvement, reviews for billing and other regulatory compliance with third party payers, revenue cycle management, as well as reimbursement methodology advisory support.

REQUIREMENTS:

• 5-7 years of multiple specialty coding auditing
• Expertise in E/M and surgical coding 5-10 specialties and high-working knowledge in more
• Experience with coding auditing associated with 1,000s of records per year
• Experience in using one or more audit tools, e.g. Audit Manager, Intellicode, MDAudit, etc.
• Comfortable in a fast-paced, short-deadline environment
• 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 practice operations, including 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 and educating physicians and other healthcare providers is preferred
• Professional services firm experience desired
• Ability to work in a fast-paced, high-volume coding audit (4-6 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 and time management
• Traits that include detail-oriented, organized, flexible, and responsive

ABOUT PYA

PYA, a leading professional services firm, serves clients across the United States with expertise in healthcare consulting, accounting, compliance, and business strategy. With offices in Knoxville, Atlanta, Tampa, Charlotte, Nashville, and Kansas City, PYA is committed to helping clients achieve their goals through innovative solutions and unparalleled service. Learn more about The PYA Way.

Why Join PYA?

• Be part of a dynamic and collaborative team that values innovation and excellence
• Work with industry leaders who are committed to professional growth and client success
• Competitive compensation, comprehensive benefits, and opportunities for career advancement