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

Keck Medicine of USC; Los Angeles (CA); On-site; USD 45,000 - 74,000; Full time

Job summary

Keck Medicine of USC in Los Angeles is seeking a Coding Compliance Auditor to perform 2nd level reviews of coded accounts, ensuring CPT, ICD-10-CM, and HCPCS accuracy with proper documentation support. You will generate audit reports, analytics, and education materials to improve compliance.

Under general supervision, you will maintain productivity, respond to inquiries, and assist in clean claim releases using Cerner, MediTech, Epic, and Athena IDX.

Qualifications

• High school or equivalent required.
• Specialized/technical training with medical terminology, anatomy & physiology and a certified coding course.
• 5 years ICD-9/ICD-10 coding and auditing experience in professional charges.
• Familiarity with CMS regulations and documentation guidance.

Responsibilities

• Perform 2nd level review of coded accounts for CPT/ICD-10-CM/HCPCS accuracy.
• Prepare detailed audit reports, excel spreadsheets, and analytics on coding accuracy.
• Educate coders/providers based on audit findings and support training.
• Respond to coding inquiries from staff and assist in timely clean claims release.
• Collaborate with Billing/CBO and ensure documentation supports coding decisions.

Skills

ICD-9/ICD-10 coding

Auditing

Documentation research

CMS regulations knowledge

Education

High school diploma or equivalent

Medical terminology & anatomy & physiology training

Certified coding course

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. Assist 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

• Req High school or equivalent
• Req 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
• Req 5 years 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

• Req Certified Professional Coder - CPC (AAPC) AAPC Certified Professional Coder (CPC), OR AHIMA Certified Coding Specialist – Physician (CCS-P)
• Req 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.
• Req 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.