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Sharp HealthCare · 2 months ago

Compliance Coding Auditor

United States

Full-time

Remote

Senior Level

$49.70/hr - $71.82/hr

5+ years exp

Sharp HealthCare is seeking a Compliance Coding Auditor to oversee and maintain their compliance audit program. This role is responsible for performing audits, chart reviews, and ensuring adherence to coding, billing, and reimbursement compliance standards.

Health CareNon Profit

Responsibilities

The Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary

Reviews the electronic health record to identify potential coding and billing compliance issues

Prepares written reports of audits, including recommendations to improve compliance

The Auditor will analyze and assess Sharp’s potential risks using SHC’s billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc

Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC’s standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies

Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program

Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education

Responsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries

Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding

Maintain professional relationship with key stakeholders focusing on high level of client satisfaction

Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians

Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire

Department management is responsible for tracking and ensuring employee receive certification within specified timeframe

Qualification

ICD-10-CM/PCS codingDRG codingCPT codingCertified Clinical Documentation Specialist (CCDS)Certified Health Care Compliance (CHC)Certified Coding Specialist (CCS)Certified Professional Coder (CPC)Microsoft Office proficiencyAnalytical abilityTime managementProblem solvingTeamwork

Required

5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT

Bachelor's degree in Business, Healthcare Administration, or related field - required. In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered

One of the following is required: AHIMA's Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification

Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire

Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes

Computer proficiency with Microsoft office applications is required

Ability to function within a fast-paced, dynamic, and growing environment

Excellent time management and problem solving skills

Must demonstrate analytical ability, motivation, initiative, and resourcefulness

Teamwork and flexibility required