Coding Compliance Specialist

A Brief Overview

The Coding Compliance Specialist performs documentation and coding audits based on multiple failed reviews as performed by the Clinical Documentation Improvement Specialists within the organization under oversight of the Supervisor of Coding Compliance to mitigate risk and ensure providers are coding and documenting in alignment with governmental standards.

• Assists in reviewing of internal data reports to identify areas of coding and documentation risk that need to be audited and reviewed to ensure the organization aligns with governmental billing, coding, and documentation standards.
• Plans and conducts routine compliance audit reviews including chart audits to evaluate the accuracy of medical codes assigned to patient services documented in a medical record.
• Performs auditing and monitoring of assigned coding and documentation related materials to ensure materials comply with governmental with applicable laws, regulations, and contractual obligations.
• Assists in the research and development of compliance tools and resources for internal use and publication by employees or team members
• Serve as a team member and assist on UH initiatives, as needed.
• Participates in meetings with and presentations to employees, providers, medical staff, and management as needed.
• Participates the annual risk assessment process in order to identify risks and potential audits for inclusion in the annual work plan.
• Works with department leadership to identify and implement improvements to Compliance & Ethics Department processes
• Prepares clear, concise, and accurate documentation and records in a timely manner and according to departmental guidelines.
• Prepares written findings and recommendations in a logical, clear, and concise manner.
• Creates and delivers coding and documentation education to prevent, mitigate, and remediate risk.

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education

• High School Equivalent / GED (Required)
• Associate's Degree (Preferred)

Work Experience

• 2 years related experience in physician coding and/or auditing. (Required)
• Related experience in provider education. (Preferred)

Knowledge, Skills, & Abilities

• Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
• Notable client service, communication, presentation and relationship building skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Strong written and verbal communication skills. (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office 365, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)

Licenses and Certifications

• Certified Professional Coder (CPC) CPC (Required) or
• Certified Professional Coder (CPC) CPC-H (Required) or
• Certified Coding Specialist (CCS) CCS-P (Required)
• CEMC - Certified Professional Coder in Evaluation and Management Coding (Required within 6 Months)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently