SUMMARY:
The Compliance Coding Auditor is responsible
for helping with the Compliance Department’s Auditing activities, including ensuring
appropriate coding by providers and internal and external coders, as well as
providing coding education as required.
The Compliance Coding Auditor audits medical and billing records for
compliance with federal and state health care program and commercial payor coding
and billing regulations and guidelines regarding the correct application of
ICD-10, CPT, HCPCS Level II and modifier coding. This position can be remote, based anywhere in
the United States, but if remote then some minor travel will be required.
Essential Duties and Responsibilities:
•
Conducts daily audits of medical
records, superbills, and other documentation to identify undercoded, upcoded,
missing, or otherwise inappropriate physician E&M and CPT services and
diagnosis codes.
•
Identifies coding error trends and
patterns and potential compliance concerns.
•
Conducts additional coding and
billing audits and reviews as assigned.
•
Follows
appropriate federal and state health care program and commercial payor billing
and coding requirements, guidelines, and best practices.
•
Maintains
current coding certification and knowledge of relevant changes to federal and
state health care program and commercial payor billing and coding requirements,
guidelines, and best practices for physician coding and diagnoses.
•
Identifies
areas for provider and coder education, and as assigned, provides relevant
coding and billing education to providers and internal and external coders.
•
Prepares
weekly, monthly, and quarterly audit reports.
•
Responds to internal inquiries
regarding best coding and billing practices and regulations.
•
Interacts when necessary with Wound
Care Centers and providers to obtain medical records and supporting
documentation.
•
Ensures strict confidentiality of
medical and financial records.
•
Reports
to Director of Compliance Audits, Senior Director of Compliance, and Vice
President Compliance Operations.
•
Performs miscellaneous job-related duties
as assigned.
•
This
position will not have supervisory responsibilities.
•
CPC
or equivalent coding certification required.
•
CHC
or other compliance certification preferred.
•
Must
have high degree of ethics and integrity.
•
Demonstrated
history of high attention to detail.
•
Associate’s
degree required; bachelor’s preferred.
•
Minimum
of three (3) years of experience auditing physician coding and diagnoses, or
five (5) years of experience doing physician-related coding, including E&M. Familiarity with coding for Hyperbaric Oxygen
Therapy, debridement, or other wound care treatments is preferred.
•
Computer
Skills: fluent with Microsoft Outlook,
Word, Excel, and Access required.
Familiarity with Verinet and Athena strongly preferred.
•
Self-starter
with excellent time-management and organizational skills.
•
Work
Environment: the incumbent in this
position is not required to work under any extreme conditions, but must be able
to work around a moderate noise level, such as an office environment.
•
Physical
Demands: the incumbent in this position
typically has to stand approximately 10% of the time, walk 10% of the time, and
sit 80% of the time.
•
Travel
approximately 5%.
Specific Individual
Considerations:
The
designation of “essential functions” and “other duties” is for purposes of
compliance with the Americans with Disabilities Act. This job description should not be construed
to imply that these requirements are the only duties, responsibilities, and
qualifications for this position.
Incumbents may be required to follow any additional related
instructions, acquire related job skills, and perform other related work as
required. Incumbents in this position
may be required to perform all or some of the above duties and responsibilities
with varying levels of concentration based on the incumbent’s skill level and company’s
needs.