Compliance & Coding Auditor

Job Responsibilities

• Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process.
• Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes.
• Performs prospective and retrospective audits to validate medical necessity and documentation supportive of code selection.
• Analyzes data to identify deficiencies, prepare reports to deliver provider education specific to training needs identified during audit.
• Develops and monitors follow-up audits and education as determined necessary to improve documentation quality. Supports all departments of the Health System with coding guidance.
• Pertaining to compliance training / 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.
• Designs training programs around compliant coding and billing from a regulatory standpoint for any new initiatives or programs affecting the Health System.
• Evaluates vendor-training materials for its application or recommendation for use in educational programs.
• Maintains: Knowledge of all State and Federal regulatory changes that impact the Health System. Revise/modifies any instructional tools as necessary based on any changes to State and Federal regulatory changes to ensure guidance and training are accurate.
• Aids 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.
• Reports on program effectiveness and documents necessary changes.

Self Development

• Participates in professional societies or organizations relevant to ICD-9-CM, ICD-10-CM, PCS and CPT.
• Maintains necessary licensure required for employment.

Job Requirements

• Minimum Education - Preferred: Associates or Bachelor’s degree in Health Information Management.
• Minimum Work Experience - Minimum 5 years acute care coding with demonstrated expertise in ICD-9-CM, ICD-10-CM, PCS and CPT coding.
• Experience, preferred, in adult and continuing education, organizational development and training.
• Required Certifications: CCA - Certified Coding Associate (AHIMA-American Health Information Management Assoc), CCS - Certified Coding Specialist (AHIMA-American Health Information Management Assoc), CCS-P - Certified Coding Specialist-Physician Based (AHIMA-American Health Information Management Assoc), CPC - Certified Professional Coder (AAPC-American Academy of Professional Coders), CPMA - Certified Professional Medical Auditor (AAPC-Academy of Professional Coders), RHIA - Registered Health Information Administrator (AHIMA-American Health Information Management Association).