Ambulatory Payment Classification (APC) Auditor - Hackensack Meridian Health

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At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Ambulatory Payment Classification (APC) Auditor performs all related internal, concurrent, prospective and retrospective coding audit activities across the Hackensack Meridian Health (HMH) network. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to APC's, ICD 10 (International Classification of Diseases), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information for process changes, risk reduction and optimization of reimbursement in accordance with coding principles and guidelines.

A day in the life of a Ambulatory Payment Classification (APC) Auditor at Hackensack Meridian Health includes:

• Assist with developing coding quality improvement initiatives.
• Analyze, review and resolve coding and documentation issues that are related to reimbursement, compliance and revenue enhancement.
• Perform focused second level coding quality reviews, as needed, to support improving coding quality.
• Document relevant trends of inaccurate coding and areas that are high risk for compliance issues.
• Assist with conducting investigation and research of existing policies, guidelines and precedent cases in publications such as Federal Register, American Hospital Association (AHA) Coding Clinic, and American Health Information Management Association (AHIMA) Journal to support internal policy development.
• Additional research will include Agency for Healthcare Research and Quality (AHRQ), Recovery Audit Program (RAC) Statement-of-Work (SOW), Office of Inspector General (OIG) Coding Compliance Plan and Correct Coding Initiative Guidelines.
• Assist with special projects assigned by management.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Education, Knowledge, Skills and Abilities Required:

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Minimum of 4+ years of experience in Hospital Trauma 1 or Academic Teaching facility.
• Excellent written and verbal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
• Detail-oriented and organized.
• Demonstrate advanced knowledge of APC-based reimbursement, medical necessity documentation requirements, guidelines for Observation services, etc.
• Knowledge of how to research within the Medicare Claims and Processing Manuals.

Education, Knowledge, Skills and Abilities Preferred:

• Associate's Degree or higher in Health Information Management or healthcare related field.
• Prior auditing experience.

Licenses and Certifications Required:

• An approved American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) coding credential.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!