OverviewThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis.
The Senior Compliance Coding Auditor will have dotted line reporting to the Chief Compliance & Risk Officer.
ResponsibilitiesEssential Functions:- Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements.
- Identify coding discrepancies and formulate suggestions for improvement.
- Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas.
- Work with medical staff department to identify and assist providers with coding.
- Report findings and recommendations to the Compliance and Executive leadership.
- Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding.
- Support compliance policies with government (Medicare & Medicaid) and private payer regulations.
- Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested.
- Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments.
- Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with all other Compliance personnel to provide coding/compliance support.
- Participates in the development and enhancement of EHR templates and programming and advises on coding compliance with payor guidelines.
- Perform other duties as assigned.
QualificationsEducation:- Associate's Degree OR High School Diploma with 7 years of experience required.
- Bachelor's Degree preferred.
Licenses/Certifications:- Certified Professional Coder (CPC®) through AAPC OR Certified Coding Specialist (CCS®) through American Health Information Management Association (AHIMA) required.
Work Experience:- 4 years experience in medical office or medical environment required
- Expert knowledge of procedural and diagnostic coding required
- Extensive knowledge of current trends in the industry based on Medicare and Texas Medicaid as well as national coding updates, such as AMA correct coding, nationally recognized coding references and/or appropriate list serves required.
- Extensive knowledge in Centers for Medicare & Medicaid (CMS) regulations required.
- Experience with Epic EHR system preferred preferred.
