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 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

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