Coding Compliance Auditor & Educator

Visa Hunt; United States; On-site; USD 95,000 - 125,000; Full time

Job summary

Wellstar Health System is seeking a Coding Compliance Auditor to conduct independent audits of professional fee coding under federal regulations. You will prepare written reports and lead provider reviews to improve documentation and coding accuracy.

The role requires CPT, ICD-10-CM, and HCPCS knowledge, plus experience with Medicaid/Medicare rules. Responsibilities include training physicians in ICD-10-CM and EMR documentation, maintaining audit records, and staying current with regulatory

Qualifications

• Requires Associate's Degree in healthcare-related field; Bachelor's degree preferred.
• Certifications: CPMA (preferred) and Certified Professional Coder/ Coding Specialist required.
• Minimum 5 years auditing or coding compliance experience in a physician practice; or 7 years in coding/billing for physician/outpatient settings.

Responsibilities

• Performs audits of clinical documentation to support codes selected by clinicians.
• Communicates audit findings clearly to physicians and staff with references.
• Conducts research related to coding and compliance issues.
• Schedules meetings with providers to review findings and improvements.
• Assists in creating/updating coding reference materials and presentations.
• Pursues continuing education to stay compliant with current laws and regulations.

Skills

Coding accuracy

Attention to detail

Public speaking

Effective communication

Time management

Independent work

Problem solving

Confidentiality

Medical documentation knowledge

Regulatory knowledge

Education

Associate's Degree in healthcare-related field

Bachelor's Degree in healthcare-related field (preferred)

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary:

Under the direction of the Coding Compliance Manager, conducts independent audits of professional fee coding. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines. Prepares written reports of findings and leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Also responsible for providing assistance with coding inquiries from providers, coding, staff, etc. This position requires knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties. Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.

Core Responsibilities and Essential Functions:

• Performs Audits
• a. Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians in accordance with professional standards, organizational policies and procedures, laws, and regulations.
• b. Creates and communicates clear and accurate audit findings to physicians and charge review staff which include references for authoritative guidance.
• c. Performs research related to compliance and coding issues.
• d. Schedules meetings with providers. Ensure compliance with coding guidelines
• a. Assist in creating and updating coding reference materials and presentations as needed.
• b. Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.

Other Activities (5)

• a. Communicate with Management regarding trends, issues or assistance needed.
• b. Maintains an accurate record of time spent on all assignments.

Required Minimum Education:

Associate's Degree from an accredited college required or in lieu of associates degree candidate must meet the minimum experience RequiredBachelor's Degree from an accredited college in a healthcare related field. Preferred

Required Minimum License(s) and Certification(s):

Cert Prof Coder 1.00 RequiredCert Coding Spec 1.00 Required

Additional Licenses and Certifications:

Certified Professional Medical Auditor CPMA Upon Hire Preferred

Required Minimum Experience:

Minimum 5 years auditing or coding compliance experience in a physician practice Required orMinimum 7 years coding or billing (Revenue Cycle) experience in a physician or outpatient coding environment. Required

Required Minimum Skills:

• High degree of coding accuracy.
• Attention to detailAbility to communicate effectively both verbally and in writing complicated coding and compliance concepts and maintain effective working relationships with physicians and staff.
• Proficient in public speaking, presentations and educational activities.
• Objective and detailed approach to problem solving.
• Extensive knowledge of Medicare regulations, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.
• Must maintain a professional appearance and demeanor while working with physicians.
• High degree of coding accuracy.
• Attention to detail.
• Must be able to learn quickly and work independently to address a variety of complex issues.
• Excellent time management skills required.
• Must be flexible and adapt well to change.
• Ability to work independently, prioritize work and meet deadlines.
• Strong Knowledge of Microsoft Word, Excel, PowerPoint and Outlook is required.
• Ability to maintain confidentiality of sensitive information.

Join us and discover the support to do more meaningful work and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.