CommonSpirit Health
Sr Coding Compliance Auditor
CommonSpirit Health, Chattanooga, Tennessee, United States, 37450
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Sr Coding Compliance Auditor
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CommonSpirit Health The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture. Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization. The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level. Responsibilities
Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims. Works to resolve claims denials and reports denial trends to leadership Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients’ chart note. Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures. Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process. Assists in the development and reporting of HCC and Pay for Performance metrics. Adheres to deadlines and ensures reports are completed and distributed to all concerned parties. Provides structured and ad hoc training/education to staff and providers. Performance necessary analysis of data for the purpose of identifying trends and making suggestions for change to process. Develop action plans based on analysis. Works collaboratively with Revenue Cycle Staff, Coding team, Clinical Informatics, and other MMS staff associated with HCC Initiative. Requirements
Associate Degree preferred. Coding Certification through American Health Information Management Association (AHIMA) as Certified Coding Specialist (CCS) or Certified Coding Specialist Physician Based (CCS-P) or the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) required. Professional Medical Auditor Certification (CPMA) (CMAS)-preferred But Not Required. CRC Certification preferred or must be obtained within the first year. What We Offer
Free Membership to our Care@Work program supporting any child care, pet care, or adult dependent needs Employee Assistance Program (EAP) for you and your family Health/Dental/Vision Insurance Flexible spending accounts Voluntary Protection: Group Accident, Critical Illness, and Identity Theft Adoption Assistance Paid Time Off (PTO) Tuition Assistance for career growth and development Matching Retirement Programs Wellness Program
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Sr Coding Compliance Auditor
role at
CommonSpirit Health The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture. Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization. The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level. Responsibilities
Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims. Works to resolve claims denials and reports denial trends to leadership Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients’ chart note. Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures. Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process. Assists in the development and reporting of HCC and Pay for Performance metrics. Adheres to deadlines and ensures reports are completed and distributed to all concerned parties. Provides structured and ad hoc training/education to staff and providers. Performance necessary analysis of data for the purpose of identifying trends and making suggestions for change to process. Develop action plans based on analysis. Works collaboratively with Revenue Cycle Staff, Coding team, Clinical Informatics, and other MMS staff associated with HCC Initiative. Requirements
Associate Degree preferred. Coding Certification through American Health Information Management Association (AHIMA) as Certified Coding Specialist (CCS) or Certified Coding Specialist Physician Based (CCS-P) or the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) required. Professional Medical Auditor Certification (CPMA) (CMAS)-preferred But Not Required. CRC Certification preferred or must be obtained within the first year. What We Offer
Free Membership to our Care@Work program supporting any child care, pet care, or adult dependent needs Employee Assistance Program (EAP) for you and your family Health/Dental/Vision Insurance Flexible spending accounts Voluntary Protection: Group Accident, Critical Illness, and Identity Theft Adoption Assistance Paid Time Off (PTO) Tuition Assistance for career growth and development Matching Retirement Programs Wellness Program
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