CommUnityCare Health Centers · 2 months ago
Senior Compliance Coding Auditor (REMOTE)
United States
Full-time
Remote
Senior Level
5+ years expCommUnityCare Health Centers is seeking a Senior Compliance Coding Auditor responsible for conducting coding audits and providing training to providers and staff. The role involves ensuring compliance with coding guidelines and regulations, as well as reporting findings and recommendations to management and executive leadership.
DentalHealth CareHospitalMedical
Responsibilities
Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant 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 the Office of the CMO and provider leadership to identify and assist providers with coding
Report findings and recommendations to Compliance Officer or designee, management, and executive leadership
Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding
Support compliance policies with government (Medicare& Medicaid) and private payer regulations
Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines
Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications
Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, 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
Assist Director of Compliance with incidents and investigations involving coding and/or documentation
Work closely with all other Compliance personnel to provide coding/compliance support
Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates
Provide training to billing coding staff on coding compliance
Participate in special projects and performs other duties as assigned
Qualification
Required
Conduct 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, CDT, HCPCS and ICD‐10 codes on an annual basis
Conduct prospective and retrospective chart reviews comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes
Identify coding discrepancies and formulate suggestions for improvement
Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas
Work with the Office of the CMO and provider leadership to identify and assist providers with coding
Report findings and recommendations to Compliance Officer or designee, management, and executive leadership
Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding
Support compliance policies with government (Medicare& Medicaid) and private payer regulations
Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines
Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications
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 for all clinical sites and departments
Assist Director of Compliance with incidents and investigations involving coding and/or documentation
Work closely with all other Compliance personnel to provide coding/compliance support
Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates
Provide training to billing coding staff on coding compliance
Participate in special projects and perform other duties as assigned
Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes
Knowledge in correct application of SNOMED, SNODENT, and LOINC
Knowledge of medical terminology, disease processes, and pharmacology
Strong attention to detail and accuracy
Excellent verbal, written, and communication skills
Excellent organizational skills
Ability to multi‐task
Proficient in Microsoft Office Suite
Critical thinking/problem solving
Ability to provide data and recommend process improvement practices
High school diploma or equivalent
5 years of healthcare experience
4 years of procedural and diagnostic coding
AAPC Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification through AHIMA
Company
CommUnityCare Health Centers
CommUnityCare Health Centers is a not-for-profit 501(c) (3) corporation providing primary care health services to the medically underserved.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Nancy Ban, MBA, MA
Chief Operating Officer
yvonne camarena
Chief Operating Officer
Recent News
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