Coding and Billing Compliance Auditor- FT- Days

Professional McAllen, Texas


Description

Position at DHR Health

POSITION SUMMARY:

The Coding and Billing Compliance Auditor is responsible for ensuring the accuracy and completeness of clinical coding that result in appropriate reimbursement and date integrity and validation of the coded information for external and internal affairs.

 

POSITION EDUCATION/ QUALIFICATIONS­:

  • High School diploma or GED required
  • CCS, CCA, COC or CPC certification required
  • Three (3) years of hospital coding experience
  • Good written and verbal communication skills are required.
  • Ability to read, write and speak English
  • Ability to communicate clearly and concisely with all levels of management.

 

 

JOB KNOWLEDGE/EXPERIENCE­:

  • Outpatient Auditing experience required
  • Auditing for all outpatient service lines, including: Emergency, Day Surgery, Endoscopy, Observation or Single Visits preferred
  • Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines
  • Extensive knowledge of reimbursement systems and regulations and policies pertaining to documentation, coding, and billing
  • Knowledge of database applications and spreadsheet design
  • Demonstrates commitment to Doctors Hospital at Renaissance Health Systems process by integrating our culture in all internal and external customer interactions

 

POSITION RESPONSIBILITES:

  • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
  • Conducts regular coding audits and coordinates ongoing monitoring of coding accuracy, providing continuous feedback to coding staff.
  • Ensures compliance with coding guidelines and company policies for complete, accurate, and consistent coding.
  • Facility OP auditing including Same Day Surgery, Observation, ED, and Ancillary visit types. Profee multi-specialty experience is a plus.
  • Provides feedback to coders and providers on coding corrections, appropriately citing authoritative resources.
  • Assists with the interpretation of codes and other information requested for accurate code assignment.
  • Communicate with management regarding clinical, coding, and reimbursement issues as needed.
  • Function in a professional, efficient, and positive manner with strong critical thinking and decision-making skills.
  • Develops and coordinates educational sessions to all coding staff regarding documentation and accurate coding.
  • Serves as a resource for coding staff on organization-wide coding and documentation standards and guidelines.
  • Designs audit tools to monitor the accuracy of clinical coding.
  • Keeps abreast of coding guidelines and reimbursement reporting requirements.
  • Conducts trend analyses to identify patterns and variations in coding practices.
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Other duties as assigned.

 

 

LINES OF REPSONSIBILITES:

(Chain-of-command)

Vice President and Chief Compliance and Privacy Officer