What are the responsibilities and job description for the Coding Compliance Auditor position at US Heart and Vascular?
Position Summary
The Coding Compliance Auditor performs internal medical record audits and prepares
compliance auditing reports, subsequent educational materials and training as directed by
the Compliance and Privacy department. Audits include regular compliance medical record audits or focused review projects for ongoing review of coding and documentation for cardiovascular specialties to support compliance with coding and documentation rules and regulations.
Responsibilities & Duties
• Performs coding audits reviewing for compliance and accuracy with CPT, ICD-10, HCPCS
and corporate coding policy and follows up for timely completion within designated time
period.
• Maintains excellent documentation of all reviews, methodologies employed, results,
corrective actions implemented, and monitoring.
• Assists in focused review projects including data analysis, reporting, and corrective action
identification and referral to the Coding Education Department.
• Reports findings of identified trends and risks to the Director of Billing and Coding
Compliance.
• Participates in the departmental meetings and provides compliance knowledge and
background as required.
• Assists the Director of Billing and Coding Compliance with the development of policies and
procedures for the compliance audit program.
• Prepares monthly, bi-monthly, quarterly and annual reports for and as directed by the
Director of Billing and Coding Compliance or the Vice President, Compliance and Privacy
Officer.
• Establishes and maintains cooperative working relationships with the corporate
management team, physician practices and all staff members to provide expertise and
compliance training as needed,
• Performs additional administrative duties as assigned by the Compliance and Privacy
department.
Minimum Qualifications
- Certification: Certified Professional Coder (CPC) from AAPC or AHIMA orequivalent (Registered Health Information Technician (RHIT), Registered Health
- Information Administrator (RHIA), Certified Coding Specialist (CCS))
- Certification: Certified Professional Medical Auditor (CPMA) from AAPC (required to obtain within 12 months of hire date) or AHIMA equivalent (Registered Health
- Information Technician (RHIT), Registered Health Information Administrator (RHIA))
- Minimum of 5 years of experience in medical coding (cardiovascular specialties preferred)
- Minimum of 2 years of experience in medical auditing (cardiovascular specialties preferred)
- Minimum of 2 years of experience in direct provider education
- Strong knowledge of healthcare regulations, billing practices, and coding standards
- Experience with compliance audits, investigations, and regulatory reporting
- Excellent communication, analytical, and leadership skills
Preferred Qualifications
- Bachelor’s degree in Health Care Administration, Public Health, Business, or related field
- Certification: Certified Cardiology Coder (CCC) from AAPC
- Experience in risk adjustment coding and health plan operations
- EClinical Works EHR experience
- Knowledge, Skills, and Abilities
- Knowledge of federal, state and local laws, statutes, regulations, codes, and standards related to the area of responsibility.
Other Qualifications
- A driver's license and proof of insurance may be required if requesting mileage reimbursement.
Work Environment
- Sedentary work environment.
- Work is generally performed in the office environment.
- Work requires limited physical, ergonomic, or emotional efforts.
- Work may generally require walking, standing, bending, kneeling, carrying light loads, and lifting no more than ten (10) pounds.
- Occasional travel may be required for audits, training or regulatory meetings.
- Environmental characteristics described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee may be exposed to medical equipment and chemicals at various times. The noise level in the work environment is usually moderate. I have read and understand the above job description.