Coding Compliance Audit & Education Specialist

About the role

Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.

Responsibilities

• Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines
• Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare
• Act as an internal expert on coding issues to ensure compliance with state and federal regulations
• Preparation of audit reports including summary of findings
• Conduct post-audit provider education with individual or large provider groups
• Schedule trainings with provider's offices, individual providers and groups of providers
• Provide feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles
• Communicate audit findings to providers to track education completion and escalation
• Interact professionally and effectively with physicians, leaders, staff, and internal teams
• Provide coding assessment, consultation, education, and issue resolution to key stakeholders as requested
• Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment
• Other duties as assigned

Requirements

• 5+ years of audit and provider education experience is preferred
• Extensive knowledge of CPT, ICD-10, and HCPCS codes and guidelines
• Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required
• Experience working with MDAudit and Athena is a plus
• Must comply with all HIPAA rules and regulations
• Excellent communication skills and the ability to work independently

Pay

• Salary range: $70,000.00 to $80,000.00 in base pay, exclusive of bonuses or benefits
• Annual bonus targeted at 15%
• Base pay offered determined based on relevant factors such as experience, education, and geographic location

Benefits

• Medical, dental, vision, life, and pet insurance
• 401K
• Paid time off
• Other wellness programs

Schedule

• Remote work option available
• Technical requirements for remote work: minimum of 5 MBPS download speed and 3 MBPS upload speed, to be acquired prior to start of employment
• Employees who regularly work from home offices are eligible for expense reimbursement to offset internet costs