Provider Coding Compliance Auditor

Baylor Scott & White Health; Dallas (TX); On-site; USD 63,000 - 95,000; Full time

Job summary

Baylor Scott & White Health is seeking a Provider Coding Compliance Consultant to support the Coding Compliance Manager and VP/Director. You will help develop, implement, and maintain BSWH policies ensuring adherence to laws and regulations across the system.

Responsibilities include auditing projects, educating providers on compliance trends, and coordinating corrective actions. Strong communication, detail orientation, and CPT/ICD-10-CM knowledge are essential.

Qualifications

• Strong written and verbal communication skills.
• Microsoft Word and Excel proficiency.
• Exercises good judgment, attention to detail, integrity, dependability and objectivity.
• Advanced knowledge of CPT, ICD-10-CM, HCPCS, CMS regulations, and payer-specific billing and documentation requirements.
• Experience auditing E/M services, surgical procedures, office-based procedures, and diagnostic services for multiple specialties with advanced knowledge in orthopedics.

Responsibilities

• Identifies appropriate projects for audits and schedules audits with appropriate personnel.
• Conducts auditing of provider services, monitoring, and investigating activities to establish compliance with BSWH policies and applicable laws.
• Provides written audit and investigation reports, identifying risks and recommending steps to improve effectiveness and mitigate risks.
• Obtains corrective action plans for identified deficiencies and follows through to ensure completion.
• Tracks audit findings and surveys personnel audited to assess audit satisfaction and effectiveness.
• Provides and coordinates coding education with providers regarding audit trends and training for compliance initiatives.
• Serves as a coding compliance resource to BSWH departments and entities on basic compliance matters.

Skills

Communication skills

Microsoft Word

Microsoft Excel

Critical thinking

Education

Bachelor's in HIM

4 years of Physician/Professional fee coding work experience

Tools

CPT

ICD-10-CM

HCPCS

CMS regulations

Payer-specific billing and documentation requirements

Job description

Baylor Scott & White Health is seeking a Provider Coding Compliance Consultant to support the Coding Compliance Manager and VP/Director. You will help develop, implement, and maintain BSWH policies ensuring adherence to laws and regulations across the system.

Responsibilities include auditing projects, educating providers on compliance trends, and coordinating corrective actions. Strong communication, detail orientation, and CPT/ICD-10-CM knowledge are essential.