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.
- 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
- 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
- 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.
- CPC, CCS-P, CEMC, or equivalent certification
- 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
- 3 or more years’ supervisory/managerial
experience in medical coding and auditing preferred
- Experience creating or revising audit
tools or processes
- 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
- 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
- Familiarity with medical terminology
- Proficient in Microsoft Office Suite (Excel, Word, Outlook,
- Proficiency in Lightspeed and Healthicity preferred
* 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.