Summary of Duties:
This is an exempt, non-clinical position. The Coding Compliance Auditor will conduct coding, documentation, and billing audits to ensure compliance with state and federal coding standards along with providing billing compliance education to providers and staff on proper coding and documentation requirements.
Essential functions:
- Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings, and proposing recommendations. Oversee implementation of audit recommendations as appropriate. Perform follow-up audits and review to monitor and validate ongoing compliance with applicable rules and guidelines.
- Maintain excellent interdepartmental communication.
- Maintain excellent documentation of all review, methodologies employed, results, corrective actions implemented, and monitoring.
- Assist in response to billing audits by analyzing risk potential, assisting in medical record collection/submission, and appealing findings.
- Assist in creating educational materials and subsequent effective roll-out via individual or classroom setting presentations.
- Participate and represent the Coding Compliance and Audit Department on committees and in meetings when requested.
Job Specifications (KSAs):
· Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.)
· Minimum of five years’ experience in physician-based healthcare setting, preferably three of which in a coding quality and/or compliance auditing position.
· Knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.
· Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.
· Strong attention to detail and analytical skills, and the ability to interpret new laws and regulations, and communicate effectively both verbally and in writing.
· Ability to work in both independent contributor and team roles (both as a team leader and team member).
· As an Exempt Employee, ability to work varying hours and days as needed to complete tasks assigned by manager.
· Availability to travel if/when on-site provider education is requested.
Position Performance Criteria:
1. Quality/Compliance- committed to delivering consistent service and outcomes to the highest standard possible every time. Effective communication across the organization to ensure we are meeting all commitments and goal aligned with the company’s core values and competencies. Demonstrates overall professionalism in attitude, demeanor, and personal appearance
2. Action/Result Oriented- takes on new opportunities and challenges with a sense of urgency, high energy and enthusiasm. Consistently achieves results under tough circumstances. Follows through on commitments with honesty, integrity and authenticity. Achieving and maintaining all productivity standards.
3. Honesty/Integrity- Gains the confidence and trust of others by exceeding our company and patient expectations. Builds partnerships and works collaboratively with others to meet shared objectives. . Exceptional service to internal and external customers. Demonstrates high reliability through consistent punctuality and attendance.
4. Resilience- Rebounds from setbacks and adversity when facing difficult situations. Is confident under pressure and can push through for results. Adapts to change with a positive attitude.
5. Plan/Align- Prioritizes work to meet commitments aligned with department, personal and company goals. Making good timely decisions within the employees’ area of responsibility that further the goals of the organization. Coordinates with other team members, including other departments, to resolve any issues that may lead to open or aging items- which may include RCM leadership when trends are identified or when an issue may need attention/escalation. Provides leadership, guidance and assistance to AR team members.
6. Follows HIPAA regulations and protects PHI.
Physical Demands:
Requires sitting for long periods of time. Work is performed in a remote office environment. Some bending and stretching are required. Manual dexterity required for use of calculator, computer keyboard and mouse.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually very quiet.
Equal Employment Opportunity
West Dermatology is committed to a policy of equal employment opportunities for applicants and Employees. Employment decisions will comply with all applicable laws prohibiting discrimination in employment, including Title VII of the Civil Rights Act of 1964, The Age Discrimination in Employment Act of 1967, the Americans with Disabilities Act of 1990, the Immigration and Nationality Act, the California Fair Employment and Housing Act, and all other applicable state and federal laws.
West Dermatology does not permit discrimination of any type against an employee because of any of the following legally protected characteristics: gender, race, color, religion, country of origin, mental disability, physical disability, marital status, gender identity, gender expression, ancestry, genetic information, medical condition, age, sexual orientation, or pregnancy.
