Coding Compliance Auditor
Responsibilities Establishes implements and maintains a review process for compliance, including a formal review (audit) process. Reviews inpatient and/or outpatient coded records for quality and comprehensive coding to ensure compliance with ICD-10-CM, CPT4, and HCPCS level II coding conventions. Analyzes and interprets coding data to identify problems or trends. Ensures compliance with coding standards and government regulations. Maintains knowledge of coding and billing requirements and regulatory changes. Assists in the ongoing development and maintenance of a coding/abstracting policies, procedure and practice standards. Audits, reports and documents all results to the Coder Manager. Provides, initiates, and supports training/education for the coding and CDMP Associates regarding coding regulations and compliance. Supports the education and compliance for CDMP post query, re-coding and re-billing process. Assists with organizational training and skills assessment for ICD-10-CM/PCS. Actively communicates and provides timely feedback to all coding and nursing associates. Ability work independently with minimum supervision Performs other duties as assigned. Qualifications: CCS certification, required. Health Information experience or RHIA/RHIT certification, required. Experience with ICD-10-CM/PCS, CPT-4 coding conventions, DRG and APC assignment, medical terminology and anatomy, required. Experience with PPS methodology for inpatient and/or outpatient encounters, required. Experience with ICD-10-CM/PCS coding classification system, required. A minimum of four years of coding experience with a least two years in a hospital setting, required. Experience in using the concepts of pathophysiology, required. Experience with inpatient and outpatient coding guidelines, required. Analytical ability to gather and interpret data, required. Associates degree in HIM or other related healthcare fields, preferred. Experience as an educator/trainer/auditor, preferred.