Coding Compliance Auditor

Company: Rochester Regional Health
Location: Rochester
Posted on: March 24, 2020

Job Description:

Coding Compliance AuditorApply NowSave JobJob SavedJob IDREQ_110930FACILITYRochester General HospitalLOCATIONRochester, New YorkSUMMARYMinimizes risk to Rochester Regional Health by conducting audits of clinical documentation and coding to ensure compliance and optimization of reimbursement. Develops education and training for coders, physicians, APPs and health care professionals based on audit findings. Performs follow up audits to ensure controls and monitors are in place to reduce risk of noncompliance, which results in reimbursement loss or fines and penalties for Rochester Regional Health. Assists manager in research and preparation of government disclosures and facilitating external government audit appeals. Work is confidential, sensitive and/or critical in nature and requires expert knowledge of coding and clinical documentation requirements. STATUS:LOCATION:DEPARTMENT:SCHEDULE:ATTRIBUTES

• Three years of recent inpatient and/or outpatient and/or physician coding experience.
• Extensive knowledge of coding principles and guidelines.
• Knowledge of RAC process including targeted coding areas
• Strong communication, organizational and time management skills.
• Results oriented with demonstrated skills in problem identification and resolution.
• Must be self-motivated and require minimal supervision with the ability to establish own priorities.
• Must have the ability to interact professionally with providers, management, and staff.
• Extensive knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing.
• Knowledge of Electronic Medical Records
• Analytical ability to gather and interpret data, to evaluate reports and track process and to determine methods for ensuring coding compliance.
• Proficient in Microsoft Office applications and others as required.
• Applicant must successfully pass a practical coding examination.
• Associates or Bachelors degree in HIM or other applicable field (e.g Business or Finance) preferred.
• Experience as an educator/trainer preferred.Required Licensure/Certification Skills:
  • Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist Certification (CCS) or Certified Coding Specialist- Physician-based (CCS-P) or Certified Professional Coder (CPC), Certified Outpatient Coding (COC) ..RESPONSIBILITIES
    • Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association.
    • Audits clinical documentation, CPT-4, HCPCS, modifiers, ICD-9 and ICD-10 coding to ensure accurate reimbursement and compliance with CMS and third party payer laws and regulations.
    • Plans and thoroughly researches topics of audits independently for quality assurance.
    • Randomly selects (as well as through selected criteria) accounts to review to enhance coding and reimbursement quality and compliance with state and federal payer regulations.
    • Utilizes Rat Stats statistical software to ensure appropriate selection of claims.
    • Develops complete reports reflecting audit findings including negative and positive trends. Reports findings to Manager or Compliance Coordinator and follows through as directed .
    • Assist Manager and/or Compliance Coordinator in researching and analyzing studies that have been prepared by government and professional associations to assess the organizations risk.
    • Reviews benchmarks for assigned areas and performs analysis to identify risk areas.
    • Assists Compliance Coordinators and Rochester Regional Health Management to identify and adjust claims for coding and revenue enhancement along with repayment of unwarranted claims.
    • Assists in preparing legal disclosures for government agencies and third party payers such as OMIG, MFCU, OIG, DOJ, FBI, third party payer fraud units.
    • Assists in researching and decision making regarding complex coding issues.
    • Assists Manager with investigations of reports of noncompliance by auditing medical records and coding.
    • Assist in annual coding reviews, create work plans based on the reviews and ensure that compliance issues and areas of risk are identified and addressed.
    • Identifies and prepares coder, physician and other health care provider education and training on clinical documentation and coding.
    • Promptly reports any and all potential compliance issues to the Director of Compliance.
    • Performs other duties as assigned.Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/VeteranApply Now

Keywords: Rochester Regional Health, Rochester , Coding Compliance Auditor, Accounting, Auditing , Rochester, New York