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Emory Healthcare · 1 week ago

Professional Coding Compliance Auditor

Atlanta, GA

Full-time

Onsite

Mid Level

3+ years exp

Emory Healthcare is a leading healthcare provider that offers a supportive environment for professional growth. They are seeking a Professional Coding Compliance Auditor who will develop and execute audits and education programs for professional billing, coding, and documentation to ensure compliance and identify reimbursement implications.

Health CareMedical

Responsibilities

Prepares and oversees professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates

Leads focused audits and reviews to assess adherence with professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas

Assists in development of organizational compliance auditing and monitoring activities for professional billing and coding, including periodic reviews of the individual department auditing and monitoring functions

Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate provider documentation

Creates audit result reports to be reviewed with providers

Organizes and schedules audit findings/education sessions with providers to review audit results

Conducts sample and focused reviews to ensure provider coding and billing is compliant with government and payor guidelines

Analyzes and reviews medical record documentation and billing data for all pertinent internal and external audits

Collaborates with clinical and administrative staff and leadership to ensure audit results are disseminated and understood

Manages investigations and audit findings in MDAudit and communicates with the Manager, Compliance Audit and Analysis if audit findings need to be escalated and entered into the Departments issues tracking system

Supports professional billing compliance education including auditing, trending, and feedback to providers and professional coders. Manages and fosters relationships with internal professional coders, coding educators and managers and third-party clinical reviewers

Assists with development and delivering educational and training programs for professional billing and clinical compliance based on the latest Federal and State regulations to appropriate providers and caregivers

Collaborates with other staff who may be conducting focused professional billing compliance audits and/or other special projects included in the annual departmental work plan

Maintains required credentials, participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e., conferences, workshops, and other professional development activities)

Actively participates in departmental meetings and activities, attends meetings and in-service/educational programs and other activities as requested

Maintains confidentiality of patient/members and staff information

Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors

Qualification

CPC certificationMDAudit EnterpriseEpic EHR systemsCoding documentation improvementBilling compliance knowledgeProject managementRoot cause analysisCritical thinkingInterpersonal skillsCommunication skillsOrganizational skillsFlexibility

Required

Bachelors degree required

Current Professional Coders (CPC) or other relevant and industry-recognized certification required

Minimum of three (3) years of experience with audit activities required

Proficient in MDAudit Enterprise software and Epic electronic health record systems

Thorough knowledge of coding documentation improvement practices

Thorough knowledge and understanding of billing, coding, and documentation requirements, Federal and State regulations, unbundling edits, medical necessity, clinical best practices, and professional billing requirements

Knowledge of legal, regulatory, and policy compliance issues related to coding, billing, procedures, and documentation

Ability to clearly communicate coding information, including the results of coding compliance audit activities

Proficiency in root cause analysis, critical thinking, and gaining acceptance of recommended solutions

Team player and understands role in relationship to others

Strong interpersonal and communication skills

Clear, concise, and persuasive writing and presentation skills

Strong orientation to deadline and detail

Strong organizational and project management skills

Working knowledge of computer software Word, Access, Excel, PowerPoint; as well as EMR

Knowledge of healthcare financial management principles/practices

Ability to work in highly matrixed environments

Ability to be flexible and adapt to change