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
Identifies coding error trends and
patterns and potential compliance concerns.
Conducts additional coding and
billing audits and reviews as assigned.
appropriate federal and state health care program and commercial payor billing
and coding requirements, guidelines, and best practices.
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.
areas for provider and coder education, and as assigned, provides relevant
coding and billing education to providers and internal and external coders.
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
Ensures strict confidentiality of
medical and financial records.
to Director of Compliance Audits, Senior Director of Compliance, and Vice
President Compliance Operations.
Performs miscellaneous job-related duties
position will not have supervisory responsibilities.
or equivalent coding certification required.
or other compliance certification preferred.
have high degree of ethics and integrity.
history of high attention to detail.
degree required; bachelor’s preferred.
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.
Skills: fluent with Microsoft Outlook,
Word, Excel, and Access required.
Familiarity with Verinet and Athena strongly preferred.
with excellent time-management and organizational skills.
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.
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.
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.