Coding Compliance Auditor & Educator

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Work Shift

Day (United States of America)

Job Summary:

Under the direction of the Coding Compliance Manager, conducts independent audits of professional fee coding. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines. Prepares written reports of findings and leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Also responsible for providing assistance with coding inquiries from providers, coding, staff, etc. This position requires knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties. Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.

Core Responsibilities and Essential Functions:

Performs Audits

• Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians in accordance with professional standards, organizational policies and procedures, laws, and regulations.
• Creates and communicates clear and accurate audit findings to physicians and charge review staff which include references for authoritative guidance.
• Performs research related to compliance and coding issues.
• Schedules meetings with providers.

Ensure Compliance with Coding Guidelines

• Assist in creating and updating coding reference materials and presentations as needed.
• Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.

Other Activities

• Communicate with Management regarding trends, issues or assistance needed.
• Maintains an accurate record of time spent on all assignments.

Required Minimum Education:

Associate's Degree from an accredited college required or in lieu of associates degree candidate must meet the minimum experience Required Bachelor's Degree from an accredited college in a healthcare related field. Preferred

Required Minimum License(s) and Certification(s):

Cert Prof Coder 1.00 Required Cert Coding Spec 1.00 Required

Additional Licenses and Certifications:

Certified Professional Medical Auditor CPMA Upon Hire Preferred

Required Minimum Experience:

Minimum 5 years auditing or coding compliance experience in a physician practice Required or Minimum 7 years coding or billing (Revenue Cycle) experience in a physician or outpatient coding environment. Required

Required Minimum Skills:

High degree of coding accuracy. Attention to detail Ability to communicate effectively both verbally and in writing complicated coding and compliance concepts and maintain effective working relationships with physicians and staff. Proficient in public speaking, presentations and educational activities. Objective and detailed approach to problem solving. Extensive knowledge of Medicare regulations, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. Must maintain a professional appearance and demeanor while working with physicians. High degree of coding accuracy. Attention to detail. Must be able to learn quickly and work independently to address a variety of complex issues. Excellent time management skills required Must be flexible and adapt well to change Ability to work independently, prioritize work and meet deadlines. Strong Knowledge of Microsoft Word, Excel, PowerPoint and Outlook is required. Ability to maintain confidentiality of sensitive information.

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