Compliance Auditor - Medical Coding (medical billing and coding)

Job Summary

Job Duties

• Performs compliance audits to determine the adequacy of medical record documentation, billing, and coding, utilizing policies, procedures, Federal and State, laws, regulations, and standard coding guidelines. Evaluates whether documentation and coding patterns present a compliance risk to the organization and provides input on recommended solutions.
• Identifies training and education needs through compliance audit results prepared and partners with peers to educate physicians and non-physician practitioners, as determined appropriate.
• Serves as a clinical coding subject matter expert for multiple assigned specialties and utilizes critical thinking when evaluating matters potentially impacting compliance. Maintain an expert level of knowledge with State and Federal healthcare program regulations.
• Works closely with revenue cycle staff to review systems and/or workflows established to ensure compliance with policies, plans, procedures, laws and regulations.
• Reviews service line operations or programs to ascertain whether audit results are consistent with established policies, procedures, procedures, Federal and State regulations.
• Identifies and defines audit scope and criteria.  and program of examination for the assigned areas being audited.
• Responsible for surveying the functions and activities in the assigned areas being audited to determine the nature of operations and adequacy of the system to achieve established objectives. Identifies key control points of assigned areas being audited.
• Obtains, analyzes, and appraises evidentiary data and available information as a basis for making an informed, objective opinion on the adequacy and effectiveness of systems and the performance of assigned areas being audited. Makes recommendations for improvement and corrective action plans where appropriate.
• Prepares accurate executive briefs showing the results of assigned areas being audited in accordance with those practices followed within the general scope of the audit parameters.
• Appraises the adequacy of corrective action taken by management to address findings identified through an external audit engagement.
• Provides input in the risk assessment process to determine specific areas of focus for compliance risk mitigation as directed by Compliance or Senior Leadership.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

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Position Details

Minimum one Coding Certification required:
--Certified Professional Coder - AAPC

--Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC)

--Registered Health Information Technician (RHIT) - American Health Information Management Association

Education

Experience

Certification(s) and License(s)