Coding & Documentation Compliance Specialist

University Health System; San Antonio (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare provider is seeking a Coding Specialist to conduct audits and investigations related to fraud and compliance. This role requires significant experience in coding and strong analytical skills. The Coding Specialist will also provide staff education on coding practices and maintain compliance with regulations.

Qualifications

• Five years experience in coding or two years with certification.
• Knowledgeable of ICD-9 and ICD-10.
• Proficiency in Microsoft Office products.

Responsibilities

• Conduct audits to ensure coding compliance with laws and regulations.
• Perform administrative investigations related to fraud and abuse.
• Conduct education programs for staff on findings from audits.

Skills

ICD-9-CM/DRG assignment

CPT4 code assignment

Chart auditing

Data collection

Statistical report generation

Knowledge of ICD-10

Knowledge of Microsoft Office products

Education

High school diploma or equivalent

Certified Coding Program or Health Information Management Program

Job description

POSITION SUMMARY/RESPONSIBILITIES
Functions under the direct supervision of the Special Investigations Unit (SIU) Manager. Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and statistical report generation. Demonstrates individual judgement, initiates work improvement methods. Will conduct administrative investigations related to fraud and abuse. Will conduct research related to eligibility, claims payment, benefits, prior authorization/referrals and contract review. Responsible for conducting and reviewing audits to assess the quality of coding and documentation to ensure compliance with federal and state laws and regulations. Responsible for researching and compiling documentation that may be reported to external regulatory and law enforcement agencies. Research and audit for accurate provider and facility payments. Identifies overpayments to provider. Assists provider, employee and contractors with the Community First Health Plan's anti-fraud program. Conducts routine education programs for staff and physicians to communicate findings from investigations, coding and documentation audits.

EDUCATION AND EXPERIENCE
High school diploma or its equivalent is required. Five years of experience with ICD-9-CM/DRG assignment, chart auditing, and CPT4 code assignment is required or only two years of experience if candidate has successfully completed a Certified Coding Program or Health Information Management Program. Must be knowledgeable of ICD-10. Must be knowledgeable of Microsoft Office products.