National Association of Latino Healthcare Executives · 9 hours ago
Coding Compliance Auditor
Wailuku, HI
Full-time
Onsite
Mid LevelThe National Association of Latino Healthcare Executives is seeking a Coding Compliance Auditor to oversee and ensure compliance in coding practices across various healthcare settings. The role involves auditing documentation, analyzing results, and providing training and recommendations for improvement in coding and documentation practices.
Health CareHospitalMedical
Responsibilities
Reviews and audits coders based on federal regulatory requirements [e.g. the Centers for Medicare and Medicaid Services (CMS)] and current documentation and coding guidelines, as well as ensuring compliance with departmental/internal policies and other applicable laws and regulations
Prepare written audit report for all noted deficiencies and make recommendations to Coding and Revenue Cycle Compliance Manager, HIM director and others as appropriated/requested (i.e. training, oversight, monitoring, process flows, etc.). Conducts trend analyses to identify patterns and variations in coding practices and case-mix index
Develop and deliver education and training programs related to results of document and coding reviews, and findings from RAC and other regulatory audits
Compares coding and reimbursement profile with regional and national norms. Reviews coding claim denials and rejections
Receives and investigates reports of compliance violations. Communicates results to HIM director and compliance officer. Ensures appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel
Qualification
Required
Coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services in all applicable health care settings
Focus on correct assignment of CPT, ICD-10, ICD-9-CM, HCPSC codes and clinician documentation
Ensure compliance with all regulatory guidelines and internal controls
Analyze audit results, identify patterns, trends or variations in coding and documentation practices
Make recommendations for improvement based on audit findings
Initiate corrective action plans to resolve problem areas identified during auditing and monitoring activity
Serve as a liaison with HIM staff, Revenue Cycle, External and Internal practitioners, and other regional departments
Review and audit coders based on federal regulatory requirements and current documentation and coding guidelines
Prepare written audit reports for all noted deficiencies
Conduct trend analyses to identify patterns and variations in coding practices and case-mix index
Develop and deliver education and training programs related to results of document and coding reviews
Compare coding and reimbursement profile with regional and national norms
Review coding claim denials and rejections
Receive and investigate reports of compliance violations
Communicate results to HIM director and compliance officer
Ensure appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
Founded in 2005
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
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