Coding Compliance Analyst

Primary Responsibilities

• Participates in the identification and resolution of areas requiring additional intervention through established Coding/Billing and Corporate Compliance work plans
• Develops and implements clinic-wide training programs geared towards educating clinical and non-clinical support staff regarding compliance related topics and/or deficiencies identified through documentation/coding and billing compliance audits
• Develops and delivers clinic-wide memorandums/educational materials pertaining to relevant revenue integrity initiatives
• Identifies trends that result in lost revenue and educates provider as appropriate
• Affixes and delivers formal review of annual CPT/Diagnosis/HCPCS changes and prepares educational documents by specialty highlighting significant changes
• Trains providers, staff, and others in small and large group sessions
• Meets deadlines, productivity targets as defined in the Coding/Billing Compliance work Plan
• Communicates effectively at all levels in the organization, including clinical and non-clinical support staff, managers, physicians, and medical leadership
• Conducts random and scheduled internal audits of physician billing and medical records documentation to ensure: Correct Coding (CPT, ICD-10, HCPCS, Modifiers), Accurate Data Entry, Accurate Charge Preparation/Processing, Compliance with governmental and third-party billing regulations
• Conducts quarterly audits of Coding staff to ensure correct coding and to identify training opportunities
• Utilizes Microsoft Excel / Word, to document and report audit results to the appropriate personnel, including physicians/providers and Medical Leadership
• Works collaboratively with clinical department physicians, mid-level providers, and other staff to ensure appropriate and compliant documentation, coding, and billing practices
• Develops and tracks progress of internal audit schedules
• Serves as an internal compliance resource for Patient Accounts, Clinical departments, and for coding and documentation questions
• Utilizes the Internet, intranet, internal reference library, available workshops and/or seminars and other sources to stay current with government and local third-party payer coding, specialty specific and reimbursement rules, and requirements
• Maintains all Professional certifications

Qualifications

• High School Diploma/GED (or higher)
• Certified Professional Coder (CPC, CCS-P, CEMC, CPMA or COC)
• 1+ years of experience utilizing standard scoring (CMS) methodologies to report findings to providers
• 1+ years of experience employing clinical references with the auditing process
• 1+ years of experience with Apply CPT and ICD-10 coding convention to documentation guidelines
• 1+ years of experience with Apply CMS and other payer constraints to final code and documentation determination
• 1+ years of demonstrated experience in a physician/professional billing environment
• 1+ years of demonstrated experience with third party payer guidelines
• Ability to obtain CPMA within 1 year of employment