Senior Compliance Coding Auditor (REMOTE)

Responsibilities

• Conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration.
• Providing training and education to providers and ancillary staff.
• Supporting the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis.

Essential Functions

• Conducting prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements.
• Identifying coding discrepancies and formulating suggestions for improvement.
• Communicating audit results/findings to providers and/or ancillary staff and sharing improvement ideas.
• Reporting findings and recommendations to compliance and executive leadership.
• Providing continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding.
• Supporting compliance policies with government (Medicare & Medicaid) and private payer regulations.
• Working closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested.
• Working with the purchasing department to order and distribute annual coding materials for all clinical sites and departments.
• Advising Compliance Officer of government coding and billing guidelines and regulatory updates and working closely with department personnel to provide coding/compliance support.
• Participating in the development and enhancement of EHR templates and programming and advising on coding compliance with payor guidelines.

Qualifications

• Proficiency in correct application of CPT, HCPCS procedure and ICD-10-CM diagnosis codes used for coding and billing for medical claims.
• High knowledge of medical terminology, disease processes and pharmacology.
• Strong attention to detail and accuracy.
• Excellent verbal, written and communication skills.
• Able to multi-task.
• Excellent organizational skills.
• Proficient in Microsoft Office Suite.
• Critical thinking/problem solving.
• Able to provide data and recommend process improvement practices.

Knowledge, Skills and Abilities

• Knowledge of current trends in the industry based on Medicare and Texas Medicaid as well as national coding updates, such as AMA correct coding, nationally recognized coding references and/or appropriate list serves.
• Extensive knowledge of Centers for Medicare & Medicaid (CMS) regulations.

Requirements

• High School Diploma or equivalent (higher degree accepted) with 5 years of experience.
• Associates Degree (higher degree accepted).
• Certified Professional Coder (CPC®) through AAPC OR Certified Coding Specialist (CCS®) through American Health Information Management Association (AHIMA) required.

Benefits

(Note: Specific benefits are not detailed in this posting.)

Pay

(Note: Specific pay details are not detailed in this posting.)

Schedule

(Note: Specific schedule details are not detailed in this posting.)