- Bachelor's Degree
- Cert Professional Coder (CPC)
POSITION DESCRIPTION:
The Compliance Auditor/Educator is a point of contact for IHA
offices for proper coding procedures and workflow for existing medical
services; provides support for the development and maintenance of IHA coding
and billing standards and IHA fees.
Educates providers and staff on correct principles, procedures, and
standards. Performs compliance and
medical record audits.
ESSENTIAL JOB FUNCTIONS:
1. Under the
direction of the Coding and Compliance Manager, performs compliance and medical
record audits; Measures compliance with IHA policies, procedures, workflow and
insurance company requirements.
2. Assists in
the planning, organizing, and completion of auditing activities required to
comply with federal payers and other compliance-related requirements.
3. Identifies
errors in coding and documentation, lost revenue opportunities and any
overpayments made due to errors in coding, insufficient medical record
documentation, and reports findings.
4. Educates
Providers on correct coding principles and works with Providers to increase and
strengthen health care providers' awareness and understanding of medical record
documentation guidelines and coding principles.
5. Provides
training for IHA staff and physicians on CPT and ICD 10 coding standards and
procedures.
6. Serves as a
role model for ethical management behavior and promotes awareness and
understanding of IHA's Standards of Care and Compliance Plan.
7. Assesses
risk and develops an audit and education plan to support the overall compliance
plan.
8. Researches
and provides written processes and guidelines for correct coding.
9. Responds to events
requests, reviews the problem and recommends solutions. Monitors the event to resolution and promotes
prevention steps.
10. Works
closely with IHA's Compliance Team to maintain coding standards and procedures
in alignment with regulatory and payer requirements.
11. Ability to
analyze RBRVU data in correlation to IHA's fee schedule; ability to effectively
navigate through NextGen and other relevant practice management systems
specifically with respect to understanding billing and office procedures.
12. Drives to
offices and other training sites to educate staff and/or providers.
13. Performs other duties as assigned.
ORGANIZATIONAL EXPECTATIONS:
1.
Creates a positive, professional,
service-oriented work environment by supporting the IHA CARES mission and core
values statement.
2.
Must be able to work effectively as a
member of the Compliance team.
3.
Successfully completes IHA's "The
Customer" training and adheres to IHA's standard of promptly providing a
high level of service and respect to internal or external customers.
4.
Maintains knowledge of and complies with
IHA standards, policies and procedures, including IHA's Employee Handbook.
5.
Maintains general knowledge of IHA office
services and in the use of all relevant office equipment, computer, and manual
systems.
6.
Serves
as a role model, by demonstrating exceptional ability and willingness to take on new and
additional responsibilities. Embraces
new ideas and respect cultural differences.
7.
Uses resources
efficiently.
MEASURED BY:
Performance
that meets or exceeds IHA CARES Values expectation as outlined in IHA
Performance Review document, relative to position.
ESSENTIAL QUALIFICATIONS:
EDUCATION: Bachelor's
Degree or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: Certified
Professional Coder designation is required; Certified Auditor or HIM
designation is preferred.
MINIMUM EXPERIENCE: 2 years of experience coding, reimbursement analysis,
insurance issue resolution and medical record auditing. Previous experience with primary care and
multi-specialty care preferred, other relevant experience would include
provider relations or customer service representative work with a health care
insurance organization. Claims payment and data management experience is highly
desirable.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
1. Demonstrated understanding and/or hands-on experience with
office processes, procedures and workflows.
2. Substantial
knowledge of managed care and insurance practices, insurance claims and billing
process, fee schedules and pricing.
Ability to research billing guidelines effectively to provide direction
on compliance coding.
3. Maintains
working knowledge of federal, state, and insurance company regulations and
contract requirements affecting compliance in a healthcare setting; compliance
plan and auditing standards.
4. Proficiency in multi-tasking and meeting sensitive
deadlines in a fast-paced environment with a personal commitment to producing
the highest quality work and providing extraordinary customer service;
demonstrated ability to effectively follow through on assigned projects.
5. Proficient in operating a
standard desktop and Windows-based computer system, including but not limited
to, Microsoft Word and Excel, PowerPoint, intranet and computer
navigation. Ability to use other
software as required while performing the essential functions of the job
including EPM and EHR systems.
6. Excellent communication skills in both written and
verbal forms, including proper phone etiquette.
Ability to present effective group educational sessions to
providers.
7. Ability to work collaboratively in a team-oriented
environment; courteous, professional and friendly demeanor.
8. Ability to work effectively with various levels of
organizational members.
9. Good organizational and time management skills to
effectively juggle multiple priorities and time constraints in a fast-paced
environment.
10. Ability to exercise sound judgment and problem-solving
skills.
11. Ability to maintain any organizational information in
a confidential manner.
12. Successful completion of IHA competency-based program
within introductory and training period.
13. Ability to
drive to offices and other training sites to educate staff and/or providers.
14. Ability to work
overtime hours as scheduled.