Coding and Compliance Auditor

Facility: 780 Main Street, Weymouth, MA 02190
Status: Full time, 40 budgeted hours per week
Shift: Day (Monday through Friday, 8:00 AM – 5:00 PM)
Hybrid position: 2 days onsite; 3 days remote option

About the Role

The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders, and other key stakeholders. The auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State, and local requirements.

Responsibilities

• Establish, implement, and maintain a formalized review process for coding compliance, including a formal review (audit) process.
• Conduct both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPCS, PCS, and ICD-10-CM codes.
• Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection.
• Analyze data to identify deficiencies, prepare reports, and deliver provider education specific to training needs identified during audit.
• Develop and monitor follow-up audits and education as determined necessary to improve documentation quality.
• Support all departments of the Health System with coding guidance pertaining to compliance training and education as requested from providers and/or staff related to coding, billing, and documentation in the inpatient, outpatient, professional, surgical, and Home Health divisions of the Health System to ensure accuracy and support program objectives.
• Design training programs around compliant coding and billing from a regulatory standpoint for any new initiatives or programs affecting the Health System.
• Evaluate vendor-training materials for its application or recommendation for use in educational programs.
• Maintain knowledge of all State and Federal regulatory changes that impact the Health System.
• Revise and modify instructional tools as necessary based on changes to State and Federal regulatory requirements to ensure guidance and training are accurate.
• Assist in the development of follow-up mechanisms to ensure that knowledge and/or skills learned in the training are being applied on the job and have an impact on staff performance in meeting organizational goals.
• Report on program effectiveness and document necessary changes.
• Design, develop, and deliver education and training programs that meet staff needs for compliant coding and billing.
• Plan and develop curriculum in accordance with the organization’s strategic goals, mission, and business strategies to improve employee performance leading to quality data and accuracy.
• Participate in professional societies or organizations relevant to ICD-9-CM, ICD-10-CM, PCS, and CPT.
• Maintain necessary licensure required for employment.
• Assist with administering programs as assigned.
• Attend and participate in organization-wide committees as assigned.
• Perform additional related duties as required.

Requirements

• Minimum 5 years of acute care coding with demonstrated expertise in ICD-9-CM, ICD-10-CM, PCS, and CPT coding.
• Experience in adult and continuing education, organizational development, and training is preferred.
• Associate’s or Bachelor’s degree in Health Information Management preferred.

Qualifications

• Required certification in one of the following:
  • CCA – Certified Coding Associate (AHIMA)
  • CCS – Certified Coding Specialist (AHIMA)
  • CCS-P – Certified Coding Specialist-Physician Based (AHIMA)
  • CPC – Certified Professional Coder (AAPC)
  • CPMA – Certified Professional Medical Auditor (AAPC)
  • RHIA – Registered Health Information Administrator (AHIMA)
• Ability to interact with constituents who have competing priorities and effectively communicate the importance of compliance in a respectful yet authoritative manner.

Pay

Compensation pay range: $73,000.00 – $104,400.00