Coding and Compliance Auditor

If you are an existing employee of South Shore Health then please apply through the internal career site. Requisition Number: R-22463 Facility: LOC0006 - 780 Main Street780 Main Street Weymouth, MA 02190 Department Name: SHS Compliance Status: Full time Budgeted Hours: 40 Shift: Day (United States of America) The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. This is a hybrid position, 2 days remote option. Compensation Pay Range: $73,000.00 - $104,400.00 Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare reports to deliver provider education specific to training needs identified during audit. Develop and monitor follow-up audits and education as determined necessary to improve documentation quality. Support all departments of the Health System with coding guidance: Pertaining to compliance training / education as requested from providers and/or staff related to coding, billing and documentation in the inpatient, outpatient, professional, surgical and Home Health divisions of the Health System to ensure accuracy and support program objectives. Designs training programs around compliant coding and billing from a regulatory standpoint for any new initiatives or programs affecting the Health System. Evaluates vendor-training materials for its application or recommendation for use in educational programs. Maintains: Knowledge of all State and Federal regulatory changes that impact the Health System Revises/modifies any instructional tools as necessary based on any changes to State and Federal regulatory changes to ensure guidance and training are accurate. Assists in the development of follow-up mechanisms to ensure that knowledge and/or skills learned in the training are being applied on the job and have an impact on staff performance in meeting organizational goals. Reports on program effectiveness and documents necessary changes. Self Development: Participates in professional societies or organizations relevant to ICD-9-CM, ICD-10-CM, PCS and CPT. Maintains necessary licensure required for employment. Administrative Duties: Assists with administering programs as assigned. Attends and participates in organization-wide committees as assigned. Performs additional related duties as required. Designs, develops and delivers education and training programs that meet the staff’s needs for compliant coding and billing. Plans and develops curriculum in accordance with the organization’s strategic goals, mission and business strategies to improve employee performance leading to quality data and accuracy. JOB REQUIREMENTS Minimum Education - Preferred Associates or Bachelor’s degree in Health Information Management. Minimum Work Experience Minimum 5 years acute care coding with demonstrated expertise in ICD-9-CM, ICD-10-CM, PCS and CPT coding. Experience, preferred, in adult and continuing education, organizational development and training. Required Certifications CCA - Certified Coding Associate (AHIMA-American Health Information Management Assoc) or CCS - Certified Coding Specialist (AHIMA-American Health Information Management Assoc) or CCS-P - Certified Coding Specialist-Physican Based (AHIMA-American Health Information Management Assoc) or CPC - Certified Professional Coder (AAPC-American Academy of Professional Coders) or CPMA -Certified Professional Medical Auditor (AAPC-Academy of Professional Coders) or RHIA - Registered Health Information Administrator (AHIMA-American Health Information Management Association) Required additional Knowledge and Abilities: Interact with constituents who have competing priorities and effectively communicate the importance of compliance in a respectful yet authoritative manner. Monday thru Friday 8am - 5pm Responsibilities if Required: Education if Required: License/Registration/Certification Requirements: Certified Coding Associate - American Health Information Management Association (AHIMA), Certified Coding Specialist - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physician Based - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator - American Health Information Management Association (AHIMA) South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services. We are the largest independent health system in Southeastern Massachusetts. South Shore Health brings together like-minded people who work “As One” toward a common goal of providing exceptional care the people of our region deserve. We unite top-caliber talent, technology, and service with the wishes and personal needs of patients and their families to develop individualized treatment plans.