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Compliance Coding Auditor Job in Nationwide, Florida

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Job Title: Compliance Coding Auditor

Required Certifications:CPC
Location: Nationwide 32250, FL, US
Date Posted:2/5/2019



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.  

To be considered for the role, please apply at 
https://ejob.bz/ATS/jb.do?reqGK=27126965&portalGK=12333 OR send your resume to Savannah Whitley at savannah.whitley@healogics.com. 

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