Compliance Coding Auditor

The Compliance Coding Auditor will be responsible for conducting scheduled audits of provider-based encounters including coding unit audits; conducting nonscheduled audits as assigned. Must have strong auditing skills with experience in multiple specialties and settings. This individual is expected to have a thorough understanding of general auditing principles and procedures including outpatient coding guidelines. Experience with multiple EMR's is preferred. Must have strong attention to detail with 95% or higher quality maintained.
 

Job Relationships

Reports to Billing Compliance Manager
 

Principal Responsibilities

• Serve as auditor of physician clinic and hospital-based coded work by the Coding Unit.
•  Audit physician medical records and charges to ensure compliance with coding standards.
• Reviews encounters to identify ICD-10-CM diagnoses, CPT/HCPCS procedures and modifiers are correct.
• Auditing all documentation to ensure third-party billing and/or Medicare criteria is met.
• Ensures all coding complies with the ethical coding standards/guidelines and regulatory requirements.
• Educate physicians and clinical staff to appropriate coding and/or documentation as required by medical review
• Works closely with the Coding Unit and Patient Accounting analysts to provide ongoing education to ensure compliance of coding regulations
• Provide coding orientation education to new Springfield Clinic providers as needed
• Maintain encounter forms for clinical use as needed for the Electronic Health Record system downtime/departments not using electronic system in posting.
• Assist in maintaining or installation of software programs to aid in maintaining compliance with existing rules/laws/regulations of state and federal programs/contractual payer agreements.
• Assist the Director or Manager with all projects in related scope of job knowledge and responsibility.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• College degree in health-related field, preferred.  High School graduate or GED minimum required.
• Minimum of 3-5 years coding & auditing experience in Physician & Facility coding. 
• Auditing experience in Physician and Hospital Coding including but not limited to:
  • Inpatient
  • OP Procedures
  • Modifier Usage
  • NCCI edits

Licenses/Certifications

• AHIMA or AAPC certifications: CPC, CCS, CCS-P, RHIT, RHIA required
• Certified Professional Medical Auditor (CPMA)

Knowledge, Skills and Abilities

• Proficient computer skills using MS-Word, Excel, PowerPoint, Outlook, Teams and Microsoft Edge, electronic medical records (EMR) systems including: Allscripts Touchworks, RCMS, RCx Rules.
• Knowledge of legal, regulatory, and policy compliance issues related to Physician medical coding and billing procedures.
• Understanding of physician and other Part B professional billing, ICD-10-CM, regulatory compliance, and internal auditing
• Expert knowledge of CPT, HCPCS, E/M leveling, Modifiers and ICD-10-CM diagnostic coding required.
• Provide excellent customer service internal and external and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Follow all Clinic operation procedures and policies.
• Ability to present and educate staff to obtain coding compliance.
• Strong analytical and communication skills.

Working Environment

• Required to attend, as directed, conferences, in-services and workshops toward further professional development and job knowledge.
• Required to travel to clinic sites as needed for educational efforts.

PHI/Privacy Level

HIPAA#1