Coding Compliance Auditor

About the Job

The Coding Compliance Auditor will be responsible for performing and assisting with all related internal and external, concurrent, prospective and retrospective coding audit activities. Coding Compliance Auditor reviews medical records to determine data quality and accuracy of coding, billing and documentation related to CPT, ICD-10-CM, and HCPCS code and modifier assignments, revenue code and regulatory requirements. They use information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders and clients in accordance with coding principles and guidelines. They will also perform direct coding for assigned clients along with direct coding coverage for clients and/or specialties, including professional fees, hospital outpatient, surgical, observation, and inpatient.

Job Duties:

Employee must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Employee will also abide by ruralMED’s policies as a condition of employment.

Direct Coding Responsibilities :

• Abstracts clinical information; translates medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems.
• Proficient in medical coding including professional fees, hospital outpatient, surgical, observation and inpatient claims.
• Sequences codes according to established guidelines.
• Ensures accurate, timely, and appropriate assignment of ICD-10, CPT/HCPCS, and modifiers for the purposes of billing, internal and external reporting, and compliance with regulatory and payer guidelines.
• Monitors and reviews client account questions in conjunction with the coding operational lead and coding director.
• Ability to independently operate within various Electronic Health Records.

• Interprets changes in the internal and external regulatory environment and stays current with corporate, state, and federal coding updates.
• Demonstrates competency annually in assigned areas of work.
• Provides coverage to clients as assigned/needed, to ensure client coding turnaround times are met.

Auditor Responsibilities

• Performs monthly and quarterly staff audits, providing feedback, education and mentoring on an individual basis. Develop any required follow-up for staff in conjunction with the Coding Manager.
• Mentors staff on an individual basis to evaluate work tasks / processes and assists staff in developing efficient and effective processes in conjunction with the Coding Manager.
• Maintains advanced knowledge of systems and billing requirements. Serves as an educational resource to educate staff.
• Performs and assists in audits and reports on the documentation and coding performed at client facilities. Reviews, develops and assists with training programs and educational materials to address deficiencies, identified in the audits, compliant with regulatory requirements.
• Performs and assists in client chargemaster chart to charge audits. Develops audit detail summary spreadsheets and reports to address coding, documentation, financial impact and profitability.
• Participates with leadership in the assessment of external audit findings and responds as needed.
• Attends meetings and interacts with leadership to resolve issues and provide advice on new programs.
• Assists coding director with maintaining coding vault assets and library of reference materials
• Develops educational materials in conjunction with the coding director

Other Responsibilities

• Adheres to the ruralMed policies and procedures, mission, vision, and values
• Adherence to local, state and federal laws and regulations

Minimum Qualifications:

• Ten (10) years of medical coding experience required; 15 years preferred.
• Ability to work independently
• High degree of analytic abilities
• Proficient with Microsoft Office
• Associate or Bachelor’s degree preferred
• Certified Coder, either Certified Professional Coder (CPC) or Certified Outpatient Coder (COC).
• Current knowledge of hospital outpatient coding and professional coding required.
• Knowledge of anatomy, physiology and medical terminology required.

Benefits

The base compensation range for this position is:

Compensation ranges could be hourly or salary depending upon the exempt status of the posted position. Compensation is only part of Ovation's total compensation package.

Some additional benefits offered to full-time associates are:

• Comprehensive health and wellness benefits such as medical, dental, vision, life insurance, short and long-term disability coverage
• HSA with employer contributions, flexible spending accounts for health care, and dependent care accounts
• Wellness platform with premium incentives
• Employee assistance support and additional voluntary supplemental plans including accident, critical illness, hospital indemnity, and child disability insurance
• Robust and flexible paid time off offerings and company paid holidays
• 401(k) plan with discretionary employer match opportunities
• Professional development opportunities
• Company issued equipment