Provider Coding Compliance Consultant

Salem Health Hospitals & Clinics; Northern (KY); Hybrid; USD 63,000 - 95,000; Full time

Job summary

Baylor Scott & White Health (BSWH) seeks a Provider Coding Compliance Consultant to support policy development and audits. Reporting to the Coding Compliance Manager, the role ensures adherence to federal, state, and local laws, and BSWH procedures.

Strong communication and coding knowledge are essential for success. The candidate will perform audits, prepare reports, coordinate corrective actions, and provide coding education to providers across BSWH.

Qualifications

• Bachelor's in HIM or 4 years of work experience above minimum qualification
• 1 year of experience required
• HIM coding credentials preferred
• CPC/CCS/CCS-P certifications encouraged

Responsibilities

• Identifies audit projects and schedules audits with appropriate personnel.
• Audits provider services, monitors compliance with BSWH policies and regulations.
• Produces written audit/investigation reports highlighting risks and corrective actions.
• Obtains and follows up on corrective action plans for deficiencies.
• Tracks findings and surveys audited personnel for audit effectiveness.
• Coordinates coding education with providers on audit trends and compliance initiatives.
• Serves as a coding compliance resource across BSWH departments.

Skills

Communication

Word

Excel

Critical thinking

Continuing education

Education

Bachelor's in HIM or 4 years of related experience

CPC

CCS

CCS-P

Tools

Microsoft Word

Microsoft Excel

Job description

Job Summary

Baylor Scott & White Health (BSWH) is committed to an effective compliance program. The Provider Coding Compliance Consultant reports to the Coding Compliance Manager works under the Compliance Vice President or Director. They perform activities related to developing, implementing, and maintaining BSWH policies. These activities ensure adherence to federal, state, and local laws and regulations.

Salary

The pay range for this position is $30.52/hour ($63,481/year) for those with entry-level qualifications up to $45.79 ($95,243) for those highly experienced. The specific rate will depend upon the successful candidate's specific qualifications and prior experience.

Essential Functions of the Role

• 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.

Key Success Factors

• Strong written and verbal communication skills with the ability to provide provider education and present audit findings.
• Proficient in Microsoft Word and Excel.
• Exercises good judgment, attention to detail, integrity, dependability, and objectivity.
• Possesses exceptional critical thinking skills.
• Demonstrates professional growth by obtaining continuing education and seeking certifications.
• Demonstrates initiative by learning business processes and applicable auditing techniques.
• HCCA Certification Preferred.
• 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

Preferred Qualifications

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

Minimum Qualifications

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
• EXPERIENCE - 1 Year of Experience