Coding Education and Compliance Auditor – Full Time (Benefit Eligible)
The Coding Education and Compliance Auditor is responsible for conducting comprehensive documentation audits to validate the integrity of ICD-10-CM diagnoses, CPT, HCPCS, modifiers and/or professional E/M codes assigned. Audits include reviewing medical records and code assignments to validate consistency with relevant laws, regulations, coding, and billing standards. The auditor analyzes audit results to identify patterns/trends and communicates findings and education to the appropriate audience.
Assists manager with improving the overall quality and completeness of provider clinical documentation to ensure medical necessity, correct coding, compliance, and appropriate reimbursement. Serve as a coding liaison with CRL providers, Business Office Operations, and all others enterprise-wide.
- Perform medical record audits on CRL providers during introductory period and annually to ensure compliance with regulatory rules and regulations. Prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance risks, if needed.
- Performs coding audits of coder work during training processes and periodically to ensure maintained quality. Feedback and training recommendations will be provided to the Manager based on coder need.
- Develops and implements provider education based on clinical documentation requirements related to regulatory and reimbursement rules and regulations, reimbursement systems (federal, state, and payer-specific), and health insurance processing.
- Responds to compliance/coding queries put forth by clinical and non-clinical providers and staff.
- Assists Manager in designing, planning, and executing of the CRL Compliance Program, including maintaining and updating CRL Physician Documentation/Coding Policy Manual.
- Work closely and collaborates with Practice Support providing documentation and coding compliance support to new and existing hospital and clinic partners.
- Maintains an open dialogue and good working relationship with CRL providers, Practice Support, Coders, CRL Business associates, and all staff to advance CRL objectives and goals.
- Other duties as assigned.
- Bachelor’s degree or Associate of Applied Science Degree in Healthcare Administration or a related field.
- Medical Coding Degree (CCS-P, CCS, CPC) required.
- RCC (Radiology Certified Coder) Degree preferred.
- CIRCC (Certified Interventional Radiology & Cardiovascular Coder) preferred.
- Minimum 5 years coding experience-Radiology required.
- Working knowledge of documentation/coding compliance guidelines (coding, billing, medical documentation, fraud, abuse, and penalties for violations).
- Ability to communicate professionally and effectively with all levels of an organization.
- Ability to maintain absolute confidentiality regarding all aspects of CRL Business Operations, physicians, employees, patients and customers.
- Ability to manage multiple tasks and prioritize appropriately.
- Experienced working in a Windows environment including MS Office (Excel, Word, Outlook, PowerPoint)
- Experience working with computer aided coding software, 3M preferred.
- Must have the ability to work successfully in a remote environment.
Physical Requirements and Work Environment:
- Frequent speaking in English, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and extended periods working at a computer.
- Have a secluded and secure office area in which to perform job duties during the workday.
- Have reliable high-speed internet access and a work environment free from distractions.