Provider Coding Compliance Auditor

Baylor Scott & White Health; Montpelier (VT); On-site; USD 31,000 - 46,000; Full time

Job summary

BSWH is seeking a Provider Coding Compliance Consultant to support the coding compliance program. The role reports to the Coding Compliance Manager and works under the Compliance VP or Director, developing, implementing, and maintaining BSWH policies to ensure adherence to laws.

The role involves auditing provider services, monitoring, reporting, and coordinating corrective actions, with emphasis on CPT, ICD-10-CM, HCPCS, and payer-specific requirements.

Qualifications

• Bachelor's in HIM or 4 years of Physician/Professional fee coding work experience.
• HCCA Certification preferred.
• Experience auditing E/M services, surgical procedures, and diagnostic services.

Responsibilities

• Identifies projects for audits and schedules audits with appropriate personnel.
• Audits provider services, monitors compliance with laws and BSWH policies.
• Provides written audit reports and recommends corrective actions.
• Obtains corrective action plans and ensures effective implementation.
• Tracks audit findings and surveys audited personnel.
• Coordinates coding education with providers on audit trends.
• Serves as coding compliance resource to BSWH departments.

Skills

Written communication

Verbal communication

Microsoft Word

Microsoft Excel

Attention to detail

Critical thinking

Professional growth

Initiative

Education

Bachelor's in HIM

4 years coding experience

Tools

CPT

ICD-10-CM

HCPCS

CMS regulations

Job description

BSWH is seeking a Provider Coding Compliance Consultant to support the coding compliance program. The role reports to the Coding Compliance Manager and works under the Compliance VP or Director, developing, implementing, and maintaining BSWH policies to ensure adherence to laws.

The role involves auditing provider services, monitoring, reporting, and coordinating corrective actions, with emphasis on CPT, ICD-10-CM, HCPCS, and payer-specific requirements.