Central Health · 5 months ago
Senior Compliance Coding Auditor
Austin, TX
Full-time
Onsite
Senior Level
5+ years expCentral Health is a healthcare organization seeking a Senior Compliance Coding Auditor. This role involves conducting billing and coding audits, providing training to staff, and ensuring compliance with coding regulations and guidelines.
Health CareHealth DiagnosticsMedical
Responsibilities
Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements
Identify coding discrepancies and formulate suggestions for improvement
Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas
Work with medical staff department to identify and assist providers with coding
Report findings and recommendations to compliance and executive leadership
Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding
Support compliance policies with government (Medicare & Medicaid) and private payer regulations
Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested
Work with the purchasing department to order and distribute annual coding materials for all clinical sites and departments
Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with department personnel to provide coding/compliance support
Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines
Perform other duties as assigned
Qualification
Required
Conduct billing and coding audits
Communicate results and recommendations to providers, management, and executive administration
Provide training and education to providers and ancillary staff
Support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis
Conduct prospective and retrospective chart reviews comparing medical record notes to reported CPT/HCPCS and ICD codes
Identify coding discrepancies and formulate suggestions for improvement
Communicate audit results/findings to providers and/or ancillary staff
Work with medical staff department to identify and assist providers with coding
Report findings and recommendations to compliance and executive leadership
Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding
Support compliance policies with government (Medicare & Medicaid) and private payer regulations
Work closely with all departments to assist in accuracy of reported services and with chart reviews
Work with the purchasing department to order and distribute annual coding materials
Advise Compliance Officer of government coding and billing guidelines and regulatory updates
Participate in the development and enhancement of EHR templates and programming
Perform other duties as assigned
Proficiency in correct application of CPT, HCPCS procedure and ICD-10-CM diagnosis codes
Knowledge of medical terminology, disease processes and pharmacology
Strong attention to detail and accuracy
Excellent verbal, written and communication skills
Ability to multi-task
Excellent organizational skills
Proficient in Microsoft Office Suite
Critical thinking/problem solving
Ability to provide data and recommend process improvement practices
High School Diploma or equivalent (higher degree accepted) with 5 years of experience
Associates Degree (higher degree accepted)
Certified Professional Coder (CPC®) through AAPC OR Certified Coding Specialist (CCS®) through AHIMA required
5 years Experience in a medical office or medical environment
5 years Experience in procedural and diagnostic coding
5 years Extensive knowledge of current trends in the industry based on Medicare and Texas Medicaid
5 years Extensive knowledge of Centers for Medicare & Medicaid (CMS) regulations
Company
Central Health
Central Health is a health care company provides access to healthcare services to eligible residents of Travis County.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jonathan Morgan
Chief Operating Officer
Alan Schalscha
Chief Medical Officer
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