Coding Compliance Auditor (Physician Services)

Description

JOB SUMMARY

Conducts risk-based coding compliance audits of inpatient and outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Understands, interprets and applies coding guidelines for coding audits. Audits inpatient and outpatient encounters code assignments. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-9/10 CM/PCS codes, MS-DRGs, CPT’s, APCs, and discharge disposition which all impact facility reimbursement.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9/10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.

FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):

• Provides input regarding departmental budget specific to area of responsibility.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to consistently and accurately audit coding of inpatient and outpatient encounters
• Ability to create clear and concise audit reports and maintain productivity standards
• Must successfully pass pre-hire coding assessment
• Knowledge of medical terminology, ICD-9/10 CM/PCS, EM, and CPT-4 coding guidelines and methodologies
• Knowledge of disease pathophysiology and drug utilization
• Knowledge of MS-DRG classification and reimbursement structures
• Knowledge of APC, OCE, NCCI classification and reimbursement structures
• Must be detail oriented and have the ability to work independently
• Computer knowledge of MS Office
• Must display excellent interpersonal skills
• Ability to demonstrate initiative and discipline in time management and assignment completion
• Ability to work in a virtual setting under minimal supervision

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Three (3) years coding experience including but not limited to hospital inpatient and outpatient encounters
• One (1) year of experience in coding audit or quality review work including but not limited to hospital inpatient and outpatient encounters.

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• AHIMA and/or AAPC Coding Credential, CCS preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position for extended periods
• Must be able to efficiently use computer, keyboard and mouse to perform audit work assignments and answer telephone
• Ability to travel
• Duties may require driving an automobile to off- site locations.
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environment

TRAVEL

• Approximately 10% travel may be required

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $30.60 - $48.80 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.