Compliance Manager, Auditing and Coding Job in Nationwide, Florida

* Other Duties:

The job description is intended to describe the general nature and level of work performed by people assigned this classification and is not designed to cover or contain a comprehensive listing of activities, duties responsibilities that are required of the employee for this job.  Management retains the discretion to add or delete the duties of the position at any time.

Job Summary:

The Compliance Manager, Auditing and Coding is responsible for managing the Compliance Department’s coding auditor staff and for planning the Department’s auditing activities related to physician outpatient (and some inpatient) coding, to ensure smooth and timely operations. This position is also responsible for training others on the proper use of systems to ensure accurate, timely, and efficient auditing and coding.  The Compliance Manager will also be heavily involved in the supervision and creation of new audit tools and processes, and the revision and ongoing improvement of existing audit tools and processes.  The Compliance Manager works closely with the Senior Director of Compliance to help promote and administer Healogics’ compliance program and fulfill its obligations under the CIA. 

Essential Functions/Responsibilities:  

• Manages the Compliance Department’s coding auditor staff, which includes participation in hiring, as well as directing and coordinating their work, coaching, training, and establishing and measuring performance goals.
• Ensures the timely completion of regular coding audits and other Compliance Department audits, with a focus on audits of outpatient physician E&M and CPT coding by internal and external coders.
• Provides daily, weekly, and monthly reporting for audit activities, as required.
• Trains and educates staff on auditing tools and coding systems.
• Creates or provides substantial input on new audit tools and processes.
• Proposes revisions to audits tools as necessary and appropriate.
• Communicates with upper management as appropriate.
• Follows-up on coding and documentation audits, including monitoring, managing, and validating, and personally conducting audits and reviews when required.
• Resolves and works to avoid coding discrepancies between external and internal coders and auditors.
• Conducts trend analyses to identify patterns and variations in coding practices and areas of heightened risk.
• Educates physicians and other providers on appropriate coding practices.
• Performs other duties as required.

Required Education, Experience and Credentials:

• CPC, CCS-P, CEMC, or equivalent certification required
• Bachelor’s Degree in Auditing or related field OR equivalent combination of education, one relevant certification as listed above, and relevant experience
• Bachelor’s Degree preferred
• 5 or more years of experience in medical coding and auditing in a medical billing office – outpatient physician E&M billing experience greatly preferred
• 3 or more years’ supervisory/managerial experience in medical coding and auditing preferred
• Experience creating or revising audit tools or processes

Required Knowledge, Skills and Abilities:

• Strong customer service skills and ability to work with internal and external customers
• Excellent knowledge of ICD-10, CPT and HCPCS coding required
• Working knowledge and understanding of billing, coding, and state and federal health care program reimbursement regulations related to wound care or Hyperbaric Oxygen Therapy Treatment is strongly preferred  
• Demonstrated history of high integrity and commitment to professional ethics
• Demonstrated analytical and problem-solving skills
• Strong organization and time-management skills
• Leadership and management skills
• Demonstrated ability to train and educate others, both one-on-one and to larger audiences
• Strong interpersonal and communication skills, including the ability to communicate clearly, concisely, and to work effectively with others
• Familiarity with medical terminology
• Proficient in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint)
• Proficiency in Lightspeed and Healthicity preferred