Provider Coding Compliance Consultant

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

Job summary

Baylor Scott & White Health in Pierre, SD is seeking a Provider Coding Compliance Consultant to support the compliance program. The role reports to the Coding Compliance Manager and collaborates with the Compliance Vice President or Director to develop and maintain BSWH policies ensuring adherence to federal, state and local laws.

Responsibilities include identifying audit projects, conducting audits of provider services, producing reports, and obtaining corrective action plans.

Qualifications

• Experience auditing provider services across multiple specialties.
• Strong CPT/ICD-10-CM/HPCS and payer rules knowledge.
• Ability to identify risks and document findings clearly.
• Strong communication and education delivery to providers.

Responsibilities

• Identifies appropriate projects for audits and schedules audits with appropriate personnel.
• Conducts auditing of provider services, monitoring, and investigating activities for compliance.
• Provides written audit reports with risks and recommended corrective steps.
• Obtains corrective action plans and ensures effective implementation.
• Tracks audit findings and surveys auditing effectiveness.
• Coordinates coding education with providers on audit trends and compliance.
• Serves as coding compliance resource to BSWH departments.

Skills

CPT knowledge

ICD-10-CM knowledge

CMS regulations

Payer-specific billing knowledge

Auditing experience

Critical thinking

Education

Bachelor's in HIM or 4 years of Physician/Professional fee coding work experience

HCCA Certification

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

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.