CHI
Overview
Sr Coding Compliance Auditor role at CHI. The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with emphasis on documentation, coding improvement, and revenue capture. This position provides education to clinicians, clinic staff, and others via face-to-face meetings, classroom settings, webinars, and online modules. It develops, maintains and presents coding and compliance educational materials to staff and clinicians, and collaborates with the coding team to support organizational needs. The role supports risk adjustment improvement efforts across the medical group and focuses on comprehensive documentation to accurately report HCCs.
Job Responsibilities
Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate accurate reporting of HCC diagnoses via claims.
Resolves claims denials and reports denial trends to leadership.
Analyzes submitted diagnosis codes versus services reflected in the chart notes.
Follows department policies on documentation to billing codes; abstracts information from chart notes based on performance program measures.
Partners with the quality team, clinically integrated network, and payers to identify trends and gaps for process improvement.
Assists in development and reporting of HCC and Pay for Performance metrics.
Meets deadlines and distributes reports to concerned parties.
Provides structured and ad hoc training to staff and providers.
Performs data analysis to identify trends and propose process changes; develops action plans based on analysis.
Collaborates with Revenue Cycle, Coding, Clinical Informatics, and other MMS staff on the HCC Initiative.
Identifies claims correction opportunities and routes them for processing.
Acts as a liaison to clinicians for documentation and coding education and follow-up to meet policies and procedures.
Conducts periodic visits to assigned offices to provide education and assist with workflow issues, building rapport with practice staff and providers.
Prepares reports and communicates audit results to management, clinicians, and committees as appropriate.
Reports areas of risk to the Coding Integrity Manager/Supervisor.
Maintains a high level of competency in clinical documentation and coding and stays current with regulations.
Demonstrates working knowledge of medical records coding concepts, terminology, and related policies.
Maintains confidentiality of patient information and participates in departmental projects to enhance efficiency and quality of care.
Job Requirements Required Education Associate Degree preferred.
Required Licensure and Certifications Coding Certification through AHIMA (CCS or CCS-P) or through AAPC (CPC) required. Professional Medical Auditor Certification (CPMA/CMAS) preferred but not required. CRC Certification preferred or must be obtained within the first year. RN, LPN, or CMA background in TN/GA preferred but not required.
Where You'll Work CHI Memorial Mountain Management (CHI Memorial Medical Group, Mountain Management Services). We are part of CommonSpirit Health and provide comprehensive office management services for Memorial Health Partners and physicians. We offer benefits to support work/life balance, including:
Care@Work program for child, pet, or adult dependent needs
Employee Assistance Program (EAP)
Health/Dental/Vision Insurance
Flexible Spending Accounts
Voluntary Protection: Accident, Critical Illness, Identity Theft
Adoption Assistance
PTO and Tuition Assistance
Matching Retirement Programs
Wellness Program
Pay Range $25.42 - $37.82 / hour
Additional Details
Seniority level:
Mid-Senior level
Employment type:
Full-time
Job function:
Finance and Sales
Industries:
Hospitals and Health Care
If you are passionate about the patient experience and ready to join our nationally recognized hospital, connect with us today!
#J-18808-Ljbffr
Job Responsibilities
Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate accurate reporting of HCC diagnoses via claims.
Resolves claims denials and reports denial trends to leadership.
Analyzes submitted diagnosis codes versus services reflected in the chart notes.
Follows department policies on documentation to billing codes; abstracts information from chart notes based on performance program measures.
Partners with the quality team, clinically integrated network, and payers to identify trends and gaps for process improvement.
Assists in development and reporting of HCC and Pay for Performance metrics.
Meets deadlines and distributes reports to concerned parties.
Provides structured and ad hoc training to staff and providers.
Performs data analysis to identify trends and propose process changes; develops action plans based on analysis.
Collaborates with Revenue Cycle, Coding, Clinical Informatics, and other MMS staff on the HCC Initiative.
Identifies claims correction opportunities and routes them for processing.
Acts as a liaison to clinicians for documentation and coding education and follow-up to meet policies and procedures.
Conducts periodic visits to assigned offices to provide education and assist with workflow issues, building rapport with practice staff and providers.
Prepares reports and communicates audit results to management, clinicians, and committees as appropriate.
Reports areas of risk to the Coding Integrity Manager/Supervisor.
Maintains a high level of competency in clinical documentation and coding and stays current with regulations.
Demonstrates working knowledge of medical records coding concepts, terminology, and related policies.
Maintains confidentiality of patient information and participates in departmental projects to enhance efficiency and quality of care.
Job Requirements Required Education Associate Degree preferred.
Required Licensure and Certifications Coding Certification through AHIMA (CCS or CCS-P) or through AAPC (CPC) required. Professional Medical Auditor Certification (CPMA/CMAS) preferred but not required. CRC Certification preferred or must be obtained within the first year. RN, LPN, or CMA background in TN/GA preferred but not required.
Where You'll Work CHI Memorial Mountain Management (CHI Memorial Medical Group, Mountain Management Services). We are part of CommonSpirit Health and provide comprehensive office management services for Memorial Health Partners and physicians. We offer benefits to support work/life balance, including:
Care@Work program for child, pet, or adult dependent needs
Employee Assistance Program (EAP)
Health/Dental/Vision Insurance
Flexible Spending Accounts
Voluntary Protection: Accident, Critical Illness, Identity Theft
Adoption Assistance
PTO and Tuition Assistance
Matching Retirement Programs
Wellness Program
Pay Range $25.42 - $37.82 / hour
Additional Details
Seniority level:
Mid-Senior level
Employment type:
Full-time
Job function:
Finance and Sales
Industries:
Hospitals and Health Care
If you are passionate about the patient experience and ready to join our nationally recognized hospital, connect with us today!
#J-18808-Ljbffr