Coding Compliance Analyst (Hybrid)

University Hospitals; Shaker Heights (OH); On-site; USD 60,000 - 90,000; Full time

Job summary

University Hospitals is seeking a Coding Compliance Analyst to perform complex professional and facility coding audits across specialties and locations within the Health System, ensuring compliance with government and payer guidelines.

You will review internal data, conduct chart audits, identify risks, and partner with staff to implement corrective actions and process improvements while safeguarding PHI. This role supports annual risk assessments and department initiatives.

Qualifications

• Experience performing healthcare coding audits across clinical settings (inpatient/outpatient).
• Strong data analysis skills to identify trends and risk areas.

Responsibilities

• Perform reviews of internal data reports to identify coding and documentation risk and audit needs.
• Plan and conduct routine and moderately complex audits, including chart reviews, to evaluate medical codes and identify corrective actions.
• Monitor coding and documentation materials for compliance with laws, regulations, and contracts.
• Research and develop compliance tools and resources for internal use and publication.

Skills

Medical coding audits

Data analysis

Regulatory compliance

Job description

A Brief Overview

The Coding Compliance Analyst performs complex professional and /or facility coding and documentation audits based on assigned specialties and/or locations of the Health System in accordance with government and commercial payer guidelines to assess and monitoring the accuracy of billing and coding as determined by data analysis of national benchmarking.

What You Will Do

• Perform reviews of internal data reports to identify areas of coding and documentation risk that need to be audited and reviewed to ensure the organization aligns with governmental billing, coding, and documentation standards.
• Plans and conducts routine and moderately complex compliance audit reviews including chart audits to evaluate the accuracy of medical codes assigned to patient services documented in a medical record and identify appropriate remedial or corrective actions.
• Performs auditing and monitoring of assigned coding and documentation related materials to ensure materials comply with governmental with applicable laws, regulations, and contractual obligations.
• Researches and develops compliance tools and resources for internal use and publication by employees or team members
• Serve as a team member and assist on UH initiatives, as needed.
• Partners with employees, providers, medical staff, and management to review the audit results and identify corrective or remedial actions to address any audit findings.
• Participates in the annual risk assessment process in order to identify risks and potential audits for inclusion in the annual work plan.
• Drafts remedial or corrective action plans and verifies that identified risks have been mitigated.
• Works with department leadership to identify and implement improvements to Compliance & Ethics Department processes and leads assigned process improvement projects.
• Prepares clear, concise, and accurate documentation and records in a timely manner and according to departmental guidelines.
• Prepares written findings and recommendations in a logical, clear, and concise manner.
• Creates and delivers coding and documentation to prevent, mitigate, and remediate risk.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.