Hospital Coding Compliance Auditor
Hospital Coding Compliance Auditor
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Job Description
Overview
Be inspired. Be rewarded. Belong. At Emory Healthcare.
At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorship and leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your career
and be what you want to be. We provide:
- Comprehensive health benefits that start day 1
- Student Loan Repayment Assistance & Reimbursement Programs
- Familyfocused benefits
- Wellness incentives
- Ongoing mentorship and leadership programs
- And more!
Description
Reporting to the Manager Compliance Audit and Analysis develops and executes audit monitoring and education for inpatient hospital billing coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluates inpatient hospital/clinical billing compliance activities to assess compliance with the Compliance Audit and Analysis Program and appropriate focus on risk areas. Serves as a resource for providers and caregivers on hospital/clinical billing and coding.
Primary duties and responsibilities:
- Prepares and oversees inpatient hospital/clinical billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
- Leads focused audits and reviews to investigate adherence with inpatient hospital/clinical billing compliance policies legal and regulatory requirements and to identify and evaluate risk areas.
- Assists in development of organizational compliance auditing and monitoring activities for hospital/clinical billing and coding including periodic reviews of the individual department auditing and monitoring functions.
- Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate documentation.
- Creates audit result reports to be reviewed with providers.
- Organizes and schedules audit findings/education sessions with providers to review audit results.
- Conducts trend analyses to identify patterns and variations in inpatient hospital/clinical billing and coding practices that indicate areas of heightened risk.
- Serves as primary lead for inpatient hospital/clinical billing compliance education including auditing trending and feedback to hospital inpatient coders and providers working in the hospital setting as applicable.
- Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers.
- Leads training on proper documentation for inpatient hospital/clinical billing and coding compliance.
- Works with the compliance operations billing team senior leaders and key department stakeholders to ensure training is current relevant and innovative.
- Evaluates training methods and modalities and works with relevant departments to implement.
- Ensures required provider compliance training related to inpatient hospital documentation coding and billing is completed on time and in accordance with compliance program policies.
- Provides counseling education and/or recommended disciplinary action if necessary or required for noncompliance with any internal or external policies and procedures related to hospital/clinical billing compliance.
- Recommends corrective action plans if necessary to address deficiencies identified by auditing and monitoring activities for specific inpatient services or on an organizationwide basis.
- Conducts audits and manages findings of audits or other reviews in MDAudit and works with the Manager Compliance Audit and Analysis if issues need to be entered into the departments issues tracking modality.
- Maintains required credentials participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e. conferences workshops and other professional development activities).
- Maintains confidentiality of patient/members and staff information.
- Performs assigned work safely adhering to established departmental safety rules and practices; reports to supervisor in a timely manner any unsafe activities conditions hazards or safety violations that may cause injury to oneself other employees patients and visitors.
Education and experience requirements:
- Bachelors degree required.
- Clinical background preferred (i.e. LPN RN etc..
- Current Certified Coding Specialist (CCS) certification required. Certification in Healthcare Compliance required.
- Minimum of three 3 years of experience with either inpatient or outpatient audit activities required.
- Proficient in MDAudit Enterprise software and Epic electronic health record systems.
- Thorough knowledge of coding documentation improvement practices.
- Thorough knowledge and understanding of hospital inpatient billing coding and documentation requirements Federal and State regulations medical necessity clinical best practices and hospital/clinical billing issues.
- Project management experience preferred.
Knowledge skills and ability requirements:
- Knowledge of legal regulatory and policy compliance issues related to coding billing procedures and documentation.
- Ability to clearly communicate coding information including the results of coding compliance audit activities.
- Proficiency in root cause analysis critical thinking and gaining acceptance of recommended solutions.
- Team player and understands role in relationship to others.
- Strong interpersonal and communication skills.
- Clear concise and persuasive writing and presentation skills.
- Strong orientation to deadline and detail.
- Strong organizational and project management skills.
- Working knowledge of computer software Word Access Excel PowerPoint; as well as EMR.
- Knowledge of healthcare financial management principles/practices.
- Ability to work in highly matrixed environments.
- Ability to be flexible and adapt to change.
Additional Details
Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.
Employment Type
Full-Time
