Compliance Coding Auditor - Integrity and Compliance Program - Full Time

Guthrie; Sayre (Bradford County); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization seeks a Compliance Coding Auditor to ensure adherence to coding guidelines and provide training to staff. This role requires strong knowledge of medical coding and at least 1 year of experience in compliance or coding. The position involves conducting audits, preparing reports, and maintaining compliance with regulatory standards in a collaborative environment.

Qualifications

• Minimum 1 year experience in coding and billing or compliance.
• 5 years clinical experience preferred.
• Must sit for CPC exam within one year.

Responsibilities

• Conduct audits for accuracy of coding and provider documentation.
• Prepare final audit reports and discuss findings.
• Educate providers and staff on coding issues.

Skills

Medical terminology

CPT, ICD-9/10 coding

Compliance guidelines

Analytical skills

Education

Associates degree

Bachelor's degree

Tools

Epic EMR

Microsoft Office

Job description

Overview

Compliance Coding Auditor – Integrity and Compliance Program – Full Time

A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic’s policies and procedures and accepted guidelines for medical coding.

Job Description

Works closely with the Compliance Officer and Compliance Coding Audit Coordinator to perform audits outlined in the work plan. Requires ability to present detailed analysis of audits in both written and spoken form. Relies on professional judgement to ensure Internal Audit and Compliance standards are used to assess compliance with CPT, ICD-9/10, HCPCS, Payor, CMS guidelines and Guthrie Clinic policies.

Responsibilities

• Conduct auditing for accuracy of coding, leveling, and provider documentation in compliance with accepted guidelines and applicable regulations (federal, state, local, insurance, Medicare, Medicaid, LCDs and NCDs).
• Perform and report coding audits based on the Internal Audit and Compliance Work Plan, prepare final reports, discuss findings with providers/staff, and maintain thorough documentation of reviews, methodologies, results, corrective actions, and monitoring.
• Complete and submit external audits from state and federal agencies; coordinate with departments to gather required documentation and communicate findings to senior leadership, providers, and staff.
• Educate and train providers and staff on coding, billing, and compliance issues.
• Develop annual work plan based on identified external and internal risks; audits include OIG, OMIG – New York, LCDs, and NCDs, with internal risk assessments and reviews of past audit findings or non-compliance.
• Maintain professional knowledge through educational opportunities, professional publications, networks, and organizations.
• Enhance department reputation by taking ownership of new requests and adding value to job accomplishments.
• Collaborate with internal billing and reimbursement departments to ensure understanding of processes.
• Maintain proficiency in Epic EMR, PARC, HIM/ROI, and Microsoft Office as needed.
• Communicate audit results to all involved parties and ensure understanding of outcomes and any corrective actions.
• Research risk areas and compliance concerns related to coding and payer requirements; provide analysis to Compliance Officers or management as required.
• Research legislation and policies related to HIPAA privacy and security regulations; provide analysis as required.

Qualifications

• Working knowledge of medical terminology, anatomy and physiology, coding guidelines (CPT, ICD-9/10-CM, HCPCS), and payer guidelines and requirements.
• Minimum 1 year of experience in physician coding and billing and/or compliance; 5 years of clinical experience and/or knowledge of Medical Records auditing preferred.
• Must sit for CPC exam within one year.

Education

• Associates degree required; Bachelor’s degree preferred.

Licenses/Certifications

• AHIMA (RHIA, RHIT, or CCS) or AAPC (CPC) required
• RN/LPN or CPMA preferred
• Must sit for CPC exam within one year

Other Duties

• Travel for this position is sometimes required.
• Participation in community and employee engagement activities is required.
• Other duties may be assigned as necessary.

About Us

Joining the Guthrie team allows you to become part of a tradition of excellence in health care. Guthrie Clinic is an Equal Opportunity Employer. Guthrie is a non-profit, integrated, physician-led organization with a multi-specialty group practice and regional office network.

Job Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Finance and Sales
• Industries: Hospitals and Health Care

Endicott, NY