What are the responsibilities and job description for the Senior Compliance Coding Auditor (REMOTE) position at CommUnityCare Health Centers?
This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis.
Essential Duties
High school diploma or equivalent. Seven years or more of relevant experience may be considered in lieu of education. Association (AHIMA).
MINIMUM EXPERIENCE
5 years of healthcare experience
4 years of procedural and diagnostic coding
REQUIRED CERTIFICATIONS/LICENSURE
Must have AAPC Certified Professional Coder (CPC®) certification or Certified Coding Specialist (CCS®) certification through American Health Information Management Association (AHIMA).
REQUIRED COURSES/COMPLETIONS (e.g., CPR)
Maintain continuing education credit to respective coding certification.
Essential Duties
- Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparingmedical and/or dentalrecord notesto reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements.
- Identify coding discrepancies and formulate suggestionsforimprovement.
- Communicate auditresults/findingsto providers and/or ancillary staff and share improvement ideas.
- Work with the Office of the CMO and provider leadership to identify and assist providers with coding.
- Reportfindings and recommendationsto Compliance Officer or designee,management, andexecutive leadership.
- Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding.
- Support compliance policies with government (Medicare& Medicaid) and private payerregulations.
- Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
- Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications.
- Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested.
- Work with the Purchasing department to order and distribute annual coding materialsfor all clinical sites and departments.
- Assist Director of Compliance with incidents and investigations involving coding and/or documentation.
- Work closelywith all other Compliance personnel to provide coding/compliance support.
- Advise ComplianceOfficer or designee of government coding and billing guidelines and regulatory updates.
- Provide training to billing coding staff on coding compliance.
- Participate in special projects and performs other duties asassigned.
- Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims.
- Knowledge in correct application of SNOMED, SNODENT, and LOINC.
- Knowledge of medical terminology, disease processes, and pharmacology.
- Strong attention to detail and accuracy.
- Excellent verbal, written, and communication skills.
- Excellent organizational skills.
- Ability to multi‐task.
- Proficient in Microsoft Office Suite.
- Critical thinking/problem solving.
- Ability to provide data and recommend process improvement practices.
High school diploma or equivalent. Seven years or more of relevant experience may be considered in lieu of education. Association (AHIMA).
MINIMUM EXPERIENCE
5 years of healthcare experience
4 years of procedural and diagnostic coding
REQUIRED CERTIFICATIONS/LICENSURE
Must have AAPC Certified Professional Coder (CPC®) certification or Certified Coding Specialist (CCS®) certification through American Health Information Management Association (AHIMA).
REQUIRED COURSES/COMPLETIONS (e.g., CPR)
Maintain continuing education credit to respective coding certification.
