Provider Coding Compliance Auditor

Baylor Scott & White Health; Providence (RI); On-site; USD 42,000 - 63,000; Full time

Job summary

Baylor Scott & White Health (BSWH) seeks a Provider Coding Compliance Consultant to develop, implement, and maintain policies ensuring compliance with federal, state, and local laws. The role reports to the Coding Compliance Manager and works with Compliance VP or Director.

Key duties include identifying audit projects, conducting audits of provider services, preparing reports, obtaining corrective actions, tracking findings, and educating providers on coding practices and compliance trends.

Qualifications

• Bachelor's in HIM or 4 years of Physician/Professional fee coding work experience
• Medical Coding Certifications such as CPC, CCS, CCS-P
• HCCA Certification preferred

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 procedures, and federal, state and local laws.
• Provides written audit and investigation reports, identifying risks and recommending appropriate steps to improve effectiveness and mitigate risks.
• Obtains corrective action plans for identified deficiencies and follows through to establish effective implementation is completed.
• 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

Attention to detail

Critical thinking

Microsoft Word

Excel

Education

Bachelor's in HIM

4 years of Physician/Professional fee coding work experience

Medical Coding Certifications CPC CCS CCS-P

HCCA Certification preferred

Tools

Microsoft Word

Excel

Job description

Baylor Scott & White Health (BSWH) seeks a Provider Coding Compliance Consultant to develop, implement, and maintain policies ensuring compliance with federal, state, and local laws. The role reports to the Coding Compliance Manager and works with Compliance VP or Director.

Key duties include identifying audit projects, conducting audits of provider services, preparing reports, obtaining corrective actions, tracking findings, and educating providers on coding practices and compliance trends.