Coding Compliance Analyst

Responsibilities

• Recognize the importance of coding and compliance in improving patient care.
• Develop, implement, and monitor systems ensuring compliance with Medicare and other payor documentation guidelines.
• Support adherence to compliance policies relating to professional coding.
• Provide new physician orientation related to regulatory compliance, documentation, and coding guidelines.
• Analyze physician practices to identify charge opportunities and ensure all billable services are captured.
• Provide in-services to providers and staff on proper coding and documentation.
• Oversee the set-up of new CPT Codes.
• Update and review fee tickets annually and ensure system files are updated accordingly.
• Identify needs for and enlist consultant services as needed.
• Participate in reimbursement analysis of professional services.
• Determine if denials relate to CPT or diagnostic coding.
• Define criteria for payor-specific reimbursement for correct payment analysis.
• Investigate payor responses to new CPT/HCPCS codes.
• Analyze and document the patient account cycle for each physician or physician line of business for timely and accurate processing.
• Provide onsite initial and ongoing CPT and ICD-9 training to providers and staff.
• Act as a resource to physicians for CPT and diagnostic coding questions.
• Perform regular audits to ensure compliance with coding and documentation guidelines.
• Provide feedback to physicians on coding and documentation accuracy, both written and verbally.

Qualifications

• Education: Associate’s degree in business or healthcare, or equivalent experience, required.
• Experience: Minimum of two years healthcare experience required. CPT/ICD9 experience in a multi-specialty setting preferred.
• Database experience preferred.
• Skills: Strong communication skills, both verbal and written. Ability to speak in front of large and small groups. Proven ability to develop training programs, provide training, and oversee work processes. Excellent organizational skills and the ability to handle large volumes of work. Demonstrated understanding of insurance reimbursement and payment methodology. Competent in Microsoft Excel and Word software.
• Licensure: RHIT, RHIA, CCS, CCS-P or CPC certification required.