Hospital Coding Compliance Auditor

Overview

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Description

Reporting to the Manager, Compliance Audit and Analysis, develops and executes audit, monitoring, and education for inpatient hospital billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluates inpatient hospital/clinical billing compliance activities to assess compliance with the Compliance Audit and Analysis Program and appropriate focus on risk areas. Serves as a resource for providers and caregivers on hospital/clinical billing and coding.

RESPONSIBILITIES:

• Compliance Audit Planning and Oversight Prepares and oversees inpatient hospital and clinical billing and coding components of the Compliance work plan, including scheduled activities and target dates.

• Leads focused audits and reviews to evaluate adherence with inpatient hospital and clinical billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.

• Assists in the development of organizational compliance auditing and monitoring activities for hospital and clinical billing and coding, including periodic reviews of departmental auditing and monitoring functions.

• Audit Execution, Reporting, and Monitoring Coordinates sample reviews to ensure billed codes are properly supported by appropriate documentation.

• Creates audit result reports for review with providers.

• Conducts audits and manages findings of audits or other reviews in MDAudit and works with the Manager, Compliance Audit and Analysis if issues need to be entered into the department's issue-tracking system.

• Risk Analysis and Compliance Review Conducts trend analyses to identify patterns and variations in inpatient hospital and clinical billing and coding practices that may indicate areas of heightened risk.

• Recommends corrective action plans, as needed, to address deficiencies identified through auditing and monitoring activities for specific inpatient services or on an organization-wide basis.

• Provider Education and Training Organizes and schedules audit findings and education sessions with providers to review audit results.

• Serves as the primary lead for inpatient hospital and clinical billing compliance education, including auditing, trending, and feedback to hospital inpatient coders and providers working in the hospital setting, as applicable.

• Manages and fosters relationships with internal coders and managers and third-party clinical reviewers.

• Leads training on proper documentation for inpatient hospital and clinical billing and coding compliance.

• Works with compliance operations, billing teams, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.

• Evaluates training methods and modalities and works with relevant departments to implement improvements.

• Ensures required provider compliance training related to inpatient hospital documentation, coding, and billing is completed on time and in accordance with compliance program policies.

• Corrective Action and Compliance Support Provides counseling, education, and/or recommended disciplinary action, if necessary or required, for non-compliance with internal or external policies and procedures related to hospital and clinical billing compliance.

• Professional Standards, Confidentiality, and Safety Maintains required credentials and participates in continuing education opportunities to remain current with billing and coding compliance best practices, including conferences, workshops, and other professional development activities.

• Maintains confidentiality of patient/member and staff information.

• Performs assigned work safely, adhering to established departmental safety rules and practices.

• Reports unsafe activities, conditions, hazards, or safety violations to the supervisor in a timely manner.

• Performs other related duties as required.

Travel

• Travel may be required based on assigned work area and business needs.

Work Type

• Work arrangement may vary based on departmental needs and assigned responsibilities.

MINIMUM QUALIFICATIONS

Education

• High school diploma or equivalent required.

Experience

• Minimum of three years of experience with inpatient or outpatient audit activities required.

Licensure/Certification

• Current Certified Coding Specialist certification required.

Preferred Qualifications

• Bachelor's degree

• Certification in Healthcare Compliance Clinical background preferred, such as LPN, RN, or other relevant clinical experience.

• Project management experience

Required Knowledge, Skills, and Abilities

• Knowledge of legal, regulatory, and policy compliance issues related to coding, billing, procedures, and documentation.

• Thorough knowledge of coding documentation improvement practices.

• Thorough knowledge and understanding of hospital inpatient billing, coding, documentation requirements, federal and state regulations, medical necessity, clinical best practices, and hospital/clinical billing issues.

• Ability to clearly communicate coding information, including results of coding compliance audit activities.

• Proficiency in root cause analysis, critical thinking, and developing recommendations that gain stakeholder acceptance.

• Strong interpersonal and communication skills.

• Clear, concise, and persuasive writing and presentation skills.

• Strong attention to detail and ability to meet deadlines.

• Strong organizational skills. Ability to work effectively in a highly matrixed environment.

• Ability to be flexible and adapt to change.

• Ability to work collaboratively as part of a team and understand the role's relationship to others.

• Working knowledge of Microsoft Word, Access, Excel, PowerPoint, and electronic medical record systems.

• Knowledge of healthcare financial management principles and practices.

Preferred Knowledge, Skills, and Abilities

• Proficiency in MDAudit Enterprise software.

• Proficiency in Epic electronic health record systems.

• Strong project management skills.

Physical Requirements

PHYSICAL REQUIREMENTS - Medium, Max 25 lbs.: up to 25 lbs., 0¿33% of the workday, occasionally; 11-25 lbs., 34-66% of the workday, frequently; 1-10 lbs., 67-100% of the workday, constantly. Lifting 25 lbs. max; carrying of objects up to 25 lbs.; occasional to frequent standing and walking; occasional sitting; close eye work, including computers, typing, reading, and writing. Physical demands may vary depending on assigned work area and work tasks.

Environmental Factors

Environmental factors may vary depending on assigned work area and tasks. Environmental exposures include, but are not limited to, blood-borne pathogen exposure, bio-hazardous waste, chemicals, gases, fumes, vapors, communicable diseases, electrical shock, floor surfaces, hot/cold temperatures, indoor/outdoor conditions, latex, lighting, patient care/handling injuries, radiation, shift work, and travel. Use of personal protective equipment, including respirators, may be required. Environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at View email address on click.appcast.io . Please note that one week's advance notice is preferred.

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Division Emory Healthcare Inc.

Campus Location Atlanta, GA, 30345

Campus Location US-GA-Atlanta

Department EHI Office of Compliance

Job Type Regular Full-Time

Job Number 164947

Job Category Revenue Cycle & Managed Care

Schedule 8a-4:30p

Standard Hours 40 Hours

Hourly Minimum USD $39.31/Hr.

Hourly Midpoint USD $47.90/Hr.

Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.