ZipRecruiter
Compliance Coding Auditor - Integrity and Compliance Program - Full Time
ZipRecruiter, Sayre, Oklahoma, United States, 73662
Overview
Option to be Hybrid/Remote.
Summary A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic’s policies and procedures and accepted guidelines for medical coding. Works closely with the Compliance Officer and Compliance Coding Audit Coordinator to perform audits outlined in the work plan. Requires ability to present detailed analysis of audits in both written and spoken form. Relies on professional judgement to ensure Internal Audit and Compliance standards are used to assess compliance with CPT, ICD-9/10, HCPCS, Payor, CMS guidelines and TGC policies.
Experience
Working knowledge of medical terminology, anatomy and physiology, and coding guidelines including CPT, ICD-9/10-CM, and HCPCS coding systems and guidelines, payer guidelines and requirements.
Minimum 1-year experience in Physician coding and billing and/or compliance field; 5 years of clinical experience and/or knowledge and understanding of Medical Records auditing process.
Required to sit for CPC exam within one year.
Education
Associates degree required; Bachelor’s degree preferred.
Licenses/Certifications
AHIMA (RHIA, RHIT, or CCS) or AAPC (CPC) required
RN/LPN or CPMA
Required to sit for CPC exam within one year
Essential Functions
Conducts auditing for accuracy of coding, leveling, and provider documentation in compliance with accepted guidelines (federal, state, local, and insurance regulations as well as The Guthrie Clinic policies, as applicable, Medicare, Medicaid, and LCD/NCD).
Performs and reports coding audits based on the Internal Audit and Compliance Work Plan, including other special auditing projects, communicates audit findings by preparing final reports and discussing findings with providers and/or staff, and maintains thorough documentation of reviews, methodologies, results, corrective actions, and monitoring.
Complete and submit external audits from state and federal agencies, coordinating with appropriate departments to gather required documentation and timely submissions; communicate external audit findings with senior leadership, providers, and staff as appropriate.
Assist in educating and training providers and staff on coding, billing and compliance issues.
Assist in developing the annual work plan based on identified external and internal risks; audits include OIG, OMIG – New York, LCDs, and NCDs; perform internal risk assessments and review past audit insufficiencies or non-compliance reports.
Maintain professional and technical knowledge by participating in educational opportunities, reading publications, networking, and engaging in professional organizations.
Enhance the compliance department and organization by taking ownership of new requests and adding value to job accomplishments.
Work closely with internal billing and reimbursement departments to ensure internal processes are understood.
Maintain knowledge and proficiency in the Epic EMR, PARC, HIM/ROI, and Microsoft Office as needed.
Communicate the results of compliance reviews/audits with all involved to ensure understanding and indicate any corrective actions required.
Research risk areas and compliance concerns related to coding and payer requirements; provide analysis to Compliance Officers or management as required.
Research legislation, standards, and policies related to HIPAA privacy and security regulations; provide analysis to Compliance Officers or management as required.
Maintain excellent documentation of all reviews, methodologies, results, corrective actions, and monitoring through departmental workplan.
Other Duties
Travel for this position is sometimes required.
Participation in community and employee engagement activities is required.
It is understood that this description is not intended to be all-inclusive and that other duties may be assigned as necessary in the performance of this position.
Rev: 7-2-2024
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Summary A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic’s policies and procedures and accepted guidelines for medical coding. Works closely with the Compliance Officer and Compliance Coding Audit Coordinator to perform audits outlined in the work plan. Requires ability to present detailed analysis of audits in both written and spoken form. Relies on professional judgement to ensure Internal Audit and Compliance standards are used to assess compliance with CPT, ICD-9/10, HCPCS, Payor, CMS guidelines and TGC policies.
Experience
Working knowledge of medical terminology, anatomy and physiology, and coding guidelines including CPT, ICD-9/10-CM, and HCPCS coding systems and guidelines, payer guidelines and requirements.
Minimum 1-year experience in Physician coding and billing and/or compliance field; 5 years of clinical experience and/or knowledge and understanding of Medical Records auditing process.
Required to sit for CPC exam within one year.
Education
Associates degree required; Bachelor’s degree preferred.
Licenses/Certifications
AHIMA (RHIA, RHIT, or CCS) or AAPC (CPC) required
RN/LPN or CPMA
Required to sit for CPC exam within one year
Essential Functions
Conducts auditing for accuracy of coding, leveling, and provider documentation in compliance with accepted guidelines (federal, state, local, and insurance regulations as well as The Guthrie Clinic policies, as applicable, Medicare, Medicaid, and LCD/NCD).
Performs and reports coding audits based on the Internal Audit and Compliance Work Plan, including other special auditing projects, communicates audit findings by preparing final reports and discussing findings with providers and/or staff, and maintains thorough documentation of reviews, methodologies, results, corrective actions, and monitoring.
Complete and submit external audits from state and federal agencies, coordinating with appropriate departments to gather required documentation and timely submissions; communicate external audit findings with senior leadership, providers, and staff as appropriate.
Assist in educating and training providers and staff on coding, billing and compliance issues.
Assist in developing the annual work plan based on identified external and internal risks; audits include OIG, OMIG – New York, LCDs, and NCDs; perform internal risk assessments and review past audit insufficiencies or non-compliance reports.
Maintain professional and technical knowledge by participating in educational opportunities, reading publications, networking, and engaging in professional organizations.
Enhance the compliance department and organization by taking ownership of new requests and adding value to job accomplishments.
Work closely with internal billing and reimbursement departments to ensure internal processes are understood.
Maintain knowledge and proficiency in the Epic EMR, PARC, HIM/ROI, and Microsoft Office as needed.
Communicate the results of compliance reviews/audits with all involved to ensure understanding and indicate any corrective actions required.
Research risk areas and compliance concerns related to coding and payer requirements; provide analysis to Compliance Officers or management as required.
Research legislation, standards, and policies related to HIPAA privacy and security regulations; provide analysis to Compliance Officers or management as required.
Maintain excellent documentation of all reviews, methodologies, results, corrective actions, and monitoring through departmental workplan.
Other Duties
Travel for this position is sometimes required.
Participation in community and employee engagement activities is required.
It is understood that this description is not intended to be all-inclusive and that other duties may be assigned as necessary in the performance of this position.
Rev: 7-2-2024
#J-18808-Ljbffr