Assists with implementing and maintaining a system-wide effective compliance program through performance of compliance and coding quality audits. Under indirect supervision, assures appropriateness and accurate coding assignments in accordance with federal coding regulations and guidelines. Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and facility fee documentation, coding and billing, including CMS and OIG compliance standards. Leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Prepares written reports of findings. Also responsible for providing assistance with coding inquiries from providers, coders, billing staff, etc. Monitors relevant resources and publications related to high-risk compliance areas. Serves as an audit software system administrator as assigned. Serves as a subject matter expert on interpretation and application of documentation and coding rules and regulations, and conduct enterprise risk assessments of potential and detected compliance deficiencies. Assists in the development of the Corporate Responsibility Annual Work Plan.
Qualifications: Bachelor or Associate's Degree in Health Information Management or related healthcare field or 5-10 years' experience as an auditor/coder within a health care organization. AAPC/AHIMA coding certifications (CPC, COC, or CCS) required. Knowledge of auditing concepts and principles. Advanced knowledge of medical coding and billing systems and regulatory requirements Ability to analyze and solve problems. Ability to clearly communicate medical information to professional practitioners. Excellent verbal/written communication skills. Excellent time management, attention to detail, follow up skills and organizational skills required. Must be flexible and adapt well to change. Ability to work independently as well as in a team environment. Must be able to prioritize work and meet deadlines. Proficiency with Microsoft Word, Excel and Power Point. Adhere to compliance and regulatory rules and regulations. Must be able to maintain the highest level of confidentiality.
EOE AA M/F/Vet/Disability