Coding Compliance Auditor - Coding Services - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

University of Southern California; Glendale (CA); On-site; USD 94,558,464 - 154,789,891; Full time

Job summary

University of Southern California is seeking a Coding Compliance Auditor to conduct 2nd level reviews of coded accounts, ensure CPT/ICD-10-CM/HCPCS accuracy, and verify documentation supports all codes. The role prepares audit reports, analyzes denial trends, and supports education for coders and providers.

Under supervision, you will use Cerner, MediTech, Epic, and Athena IDX to ensure clean claims and timely billing, while responding to inquiries from staff and providers.

Qualifications

• High school diploma or equivalent required.
• Specialized training in Medical Terminology, Anatomy & Physiology and a coding course.
• 5+ years of ICD-9/ICD-10 coding and auditing experience in professional settings.

Responsibilities

• Perform monthly coding audits to assess accuracy and compliance.
• Prepare reports and data analyses on coding accuracy, denials, and compliance.
• Educate staff on audit findings and coding guidelines.

Skills

Auditing

Coding compliance

Data analysis

CMS regulations

Communication

Education

High school diploma

Coding training/certificate

Tools

Cerner

MediTech

Epic

Athena IDX

Job description

In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments – and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant. The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics re: coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems such as Cerner, MediTech, Epic, and Athena IDX in a manner to assure clean claims release for billing in a timely manner. Participate in response to inquiries regarding coding and documentation from coders, providers, and all other hospital staff. Perform other coding department related duties as assigned by Coding management.

• CODING AUDITING
  1. Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a required coding accuracy rate.
  2. Develops monitoring/education plans for coding staff who do not meet the required accuracy rate.
  3. Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
  4. Ability to act as a resource to coding staff, USC Care staff, and providers on coding issues and questions.
  5. Ability to achieve a 95% accuracy rate as determined by an annual external review of coding.
• UNDER GENERAL SUPERVISION, RESPONSIBLE FOR
  1. Professional coding of all diagnostic and procedural information from the medical records using ICD-10-CM, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.
  2. Works cooperatively with Coding Support and/or CBO, in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.
  3. Attendance, punctuality, and professionalism in all Coding and work-related activities.
  4. Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications, and actions. Completes tasks accurately, legibly, and in a timely fashion.
  5. Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.
• TIMELINESS OF AUDITING/CODING & PRODUCTIVITY
  1. Maintains at minimum, expected productivity standards, and strives to maintain a steady level of productivity and provides consistent effort.
  2. Works coding queues/task lists to ensure charges are released within defined timelines.
  3. Assists other coders in performance of duties including answering questions and providing guidance, as necessary.
  4. Assists Billing department, USC Care coding department, and other departments in addressing coding issues/questions and/or providing information so that an charges can be generated. Assists physicians, APPs, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed.
  5. Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority.
• POLICY & PROCEDURES; PERFORMANCE IMPROVEMENT
  1. Consistently adhere to coding policies and procedures as directed by Coding management.
  2. Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed.
  3. Participates in continuously assessing and improving departmental performance.
  4. Ability to communicate changes to improve processes to the director, as needed.
  5. Assists in department and section quality improvement activities and processes (i.e. Performance Improvement).
• COMMUNICATION
  1. Works and communicates in a positive manner with management and supervisory staff, medical staff, co-workers and other healthcare personnel.
  2. Ability to communicate effectively intra-departmentally and inter-departmentally.
  3. Ability to communicate effectively with external customers.
  4. Provides timely follow-up with both written and verbal requests for information, including voice mail and email.
• Performs other duties as assigned.

Required Qualifications:

• High school or equivalent.
• Specialized/technical training – Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding course.
• Combined education/experience can substitute for completion of Specialized/Technical Training Courses.
• Five (5) -years of experience in ICD-9 & ICD-10 (combined) coding and auditing of Professional charges, E/M, surgical, and multispecialty medical records in the clinic and hospital setting and experience in researching CMS regulations and guidance for documentation and coding.

Required Licenses/Certifications:

• Certified Professional Coder – CPC (AAPC) or AHIMA Certified Coding Specialist – Physician (CCS-P).
• Successful completion of the professional specific coding test – with a passing score of 85%. The coding test may be waived for former USC or agency/contract Coding Dept. coders who historically/previously met the 90% internal/external audit standards of the previously held USC Job Code.
• Fire Life Safety Training (LA City). If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only).

The hourly rate range for this position is $33.00 – $54.02.

When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.