Senior Compliance Coding Auditor

Overview

This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis.

Responsibilities

Essential Functions :

• Conduct 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.
• Identify coding discrepancies and formulate suggestions for improvement.
• Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.
• Work with medical staff department to identify and assist providers with coding.
• Report findings and recommendations to compliance and executive leadership.
• Provide continuing education to providers and ancillary staff on CPT / HCPCS and ICD-9 / 10 coding.
• Support compliance policies with government (Medicare & Medicaid) and private payer regulations.
• Work 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.
• Work with the purchasing department to order and distribute annual coding materials for all clinical sites and departments.
• Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with department personnel to provide coding / compliance support.
• Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines.
• Perform other duties as assigned.

Knowledge, Skills and Abilities :

Qualifications

Education :

Licenses / Certifications :

Required Work Experience :