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County of Riverside · 2 months ago

Healthcare Coding Compliance Auditor - RUHS MC

Riverside County, CA

Full-time

Onsite

Senior Level

5+ years exp

County of Riverside is seeking a skilled Coding Compliance Auditor to support the Compliance Department. The Compliance Auditor will review inpatient and outpatient medical records to ensure quality, accuracy, and comprehensive coding in accordance with regulations.

GovernmentHealth CarePublic RelationsPublic SafetySocial

No H1B

U.S. Citizen Only

Responsibilities

Conduct thorough reviews of medical records for compliance with coding regulations

Provide feedback and education to coders and physicians to improve coding accuracy and documentation

Perform annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested

Communicate effectively with all RAC stakeholders, ensuring timely and accurate responses to inquiries

Support ongoing program development through training initiatives and process improvements

Deliver coding presentations to diverse audiences, including physicians

May supervise departmental staff as needed

Establishes implements and maintains a review process for coding/CDI compliance, including a formal review (audit) process

Reviews inpatient and/or outpatient coded records for quality and comprehensive coding and documentation 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 clinical documentation Integrity, 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 Compliance officer utilizing spreadsheet/software algorithms as necessary

Provides, initiates, and supports training/education for the coding and compliance regulations to all RUHS staff as needed

Creates videos and educational modules on updates as required

Supports the education and compliance for RUHS 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 affiliates as necessary

Ability work independently with minimum supervision

Qualification

ICD-10 codingCPT codingHCPCS codingCertified Professional Medical AuditorLead/supervisory experienceOrganizational skillsCommunication skills

Required

Minimum of five (5) years' experience coding inpatient and/or outpatient hospital records using ICD-10, CPT, HCPCS, and other third-party payor codes

At least two (2) years of lead or supervisory experience

Strong organizational and communication skills, comfortable interacting with physicians and various stakeholders

Graduation from an accredited college or university with a bachelor's degree, preferably with a major in accounting, business or public administration, information services, finance, or a closely related field to the assignment

Three years of experience in an administrative or staff capacity which must have included at least two years of experience supervising professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization

Must possess and maintain at least one of the following: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Tech/Administrator (RHIT/RHIA), Certified Document Integrity Practitioner (CDIP), Certified Professional Medical Auditor (CPMA)

Preferred

Certified Professional Medical Auditor (CPMA) certification preferred

The ideal candidate for this position will possess five (5) years of experience coding inpatient and/or outpatient records in a hospital utilizing ICD-10/CPT/HCPCS and other third-party payor codes. This experience must include at least two (2) years of lead or supervisory experience