|Required Experience:||3 to 4 years
POSITION WILL WORK REMOTELY EXCEPT FOR REQUIRED TRAVEL FOR MEETINGS, TRAININGS, ETC.
Job Purpose: The primary responsibility of the Coding Compliance Specialist is to provide audits and subsequent education to providers for the purpose of clinical documentation improvement to mitigate financial risk.
Essential Job Functions:
1. Ability to perform “start to finish” audits: conduct reviews for compliance from the point of intake (coordination of benefits), documentation of clinical services rendered, charge capture, filing of claims and reimbursement.
2. Performs/manages audits and reviews of medical record documentation, coding and filing of claims to detect areas of non-compliance .
3. Make recommendations for corrective action related to areas of documentation, coding and claim non-compliance.
4. Make recommendations to the Executive Steering Committee regarding auditing and monitoring projects. Draft Audit Plans for approval.
5. Assists C-level executives with developing or revising policies and procedures to comply with changes in the law or regulations as necessary and appropriate.
6. Assists in preparing formal responses to governmental or other regulatory audits and inquiries.
7. Maintains accurate documentation of all complaints, investigative findings, corrective actions and final resolutions.
8. Assesses compliance education needs of the workforce and develops content and curriculum of compliance training in areas of documentation, coding and claims filing for Psychiatry.
9. Assures timely training of new workforce members and periodic re-training of the workforce and maintains documentation of same.
10. Documents performance improvement and measures success as reported to C-level executives.
11. Maintains current policies, procedures, and guidelines related to auditing and monitoring documentation, coding and reimbursement compliance.
12. Demonstrate knowledge of emergency procedures and assist in crisis situations.
13. Demonstrate knowledge of and comply with all agency policies and procedures.
14. Complete all other relevant responsibilities as assigned by the supervisor.
15. Driving and travel may be required.
1. LPN, RN or Bachelor's Degree of business, healthcare, or a related field recommended.
2. Minimum of three years of experience coding and auditing outpatient psychiatric records.
3. Experienced coding and documentation trainer with health care providers.
4. Ability to apply laws and regulations within healthcare operations.
5. Ability to work with all levels within the organization on compliance issues.
6. Project management experience and understanding of root cause analysis and process improvement preferred.
7. Experience in project, team management/leadership required
8. Valid North Carolina Driver License.
9. One (or more) of the following:
CHA – Certified Healthcare Auditor (AIHC)
CMHCS - Certified Mental Health Coding Specialist (PAHCS)
CCA – Certified Coding Associate (AHIMA)
CCS-P – Certified Coding Specialist-Physician (AHIMA)
CPC – Certified Professional Coder (AAPC)
CPMA – Certified Professional Medical Auditor (AAPC)
10. Preferred Experience in the following business tools:
Office365 Product Suite: Sharepoint, OneDrive, Excel, Word, PowerPoint
Skype for Business
The Echo Group Revenue Manager
Intelicode Auditing Software