Job Requirements Responsible for ensuring that all aspects of documentation, coding, and billing practices are in compliance with applicable laws, regulations, guidelines, and UMMS policies and procedures. Conduct audits to identify areas of non-compliance, assess risks, and collaborate with key stakeholders to monitor corrective measures when indicated. Responsible for validating that data abstracted from the electronic health record (EHR) is coded according to ICD-10-CM, CPT, HCPCS, AMA CPT guidelines, E/M guidelines, and CMS standards. Work is performed under limited supervision. Direct report to the Manager, Coding Compliance Training.
• Conduct independent compliance audits and review on the adequacy of medical record documentation to support the codes selected by providers and/or coders.
• Verify compliance with CMS guidelines, CPT, HCPCS, and ICD-10 standardized code sets, and internal coding and billing policies via documentation and coding review audits.
• Assist with reporting audit results, trending and tracking regulatory updates, responding to compliance inquiries, preparing education materials, and providing compliance educational support and training to providers and/or coders.
• Perform compliance documentation and coding audits using department's MDaudit software.
• Analyze documentation and/or coding patterns by a provider, division, or department that poses a compliance risk and provide recommendations to mitigate risks.
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5• Present audit findings and recommendations to key stakeholders including but not limited to individual providers, provider groups, and practice administrators.
• Develop and administer training and educational materials to address documentation and coding deficiencies identified in audits; support the development and administration of system-wide compliance education (e.g., New Provider Compliance Education and Annual Compliance Education).
• Prepare reports for the Chief Compliance, Audit and Provider Officer, Vice President, Compliance Operations, Director, Revenue Cycle Billing and Coding Compliance, Manager, Coding Compliance and Training, UMMS Executive Management and the Audit and Compliance Committee of the Board of Directors.
• Conduct regulatory research, prepare draft responses to compliance inquiries for providers, administrators, and management.
• Monitor, track, and report regulatory updates regarding government billing and coding regulations.
• Log compliance incidents, inquiries, and investigations and supporting documentation in department's case management system; complete assigned cases.
• Support compliance investigations.
• Draft policies, standard operating procedures, and prepare tools (e.g., toolkits, checklists).
• Meet department key performance indicators including but not limited to case turnaround time, audit productivity, and quality metrics.
• Perform other duties as assigned.
Work Experience • High school diploma.
• Five (5) years' experience in coding including two (2) years of auditing/billing compliance experience.
• Certified Professional Coder (CPC) certification.
• Working knowledge of CPT, ICD-10 and HCPCS coding and modifiers for appropriate reporting of patient services.
• Working knowledge of healthcare regulatory and compliance issues.
• Working knowledge of compliance auditing and monitoring techniques related to documentation and coding.
• Working knowledge of compliance audit software (e.g., MDaudit) or similar software.
• Ability to maintain confidentiality of all compliance related or other reported issues.
• Keen sense of personal responsibility and accountability for delivering high quality work.
• Effective analytical, critical thinking, planning, organizational, and problem-solving skills.
• Ability to work independently and in a team environment, with strong collaboration skills.
• Ability to analyze, compare, contrast, and validate work with keen attention to detail.
• Self-motivated individual who can excel with little supervision and has the ability to be successful in a fast paced, dynamic environment.
• Ability to evaluate the scope of each day's work and use time management and organizational skills to complete assignments in a timely manner.
• Effective skill in the use of Microsoft Office Suite (e.g., Word, Excel, PowerPoint).
• Effective verbal, written, and interpersonal communication skills.
Benefits Compensation:
- Pay Range: $33.40- $50.13
- Other Compensation (if applicable):
