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*Northern California Medical Associates is an Equal Opportunity Employer
Position Title: Coding Compliance Auditor
Reports To: Coding Manager
FLSA Status: Non-Exempt
Location: Billing Department
Summary: The Coding Compliance Auditor performs audits of medical records to ensure compliance with coding and documentation guidelines. The auditor works closely with the Coding Manager and Director of Business Services to provide coding and documentation education. Additionally, the auditor provides physicians with routine feedback on their documentation and compliance with standards.
Duties and Responsibilities (includes, but is not limited to the following):
• Audits medical records to identify coding variances; prepares reports of findings.
• Provides educational support to medical providers regarding coding compliance, documentation, regulatory provisions, and third party payer requirements.
• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Interacts with patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification on any conflicting, ambiguous, or non-specific documentation.
• Travels to medical offices to complete necessary training.
• Provides feedback to physicians related to documentation issues and/or revenue opportunities.
• Ensures all services are accounted for and billed.
• Keeps abreast of coding guidelines and reimbursement reporting requirements.
• Adheres to official coding guidelines.
• Queries physicians when code assignments are not straightforward or documentation in medical record is inadequate, ambiguous, or unclear for coding purposes.
• Ensures coded services, provider charges and medical record documentation meet appropriate guidelines or standards.
• This position has no direct supervisory responsibilities.
Education, Licensure and/or Certifications
• High school diploma or GED
• Coding certification required (AAPC or AHIMA), CDI, evaluation and management, or compliance certification encouraged.
• One year of medical coding experience in a health care organization.
• Typing ability of 40 wpm.
• Word processing and computer experience.
Knowledge, Skills and Abilities
• Knowledge of medical records coding procedures.
• Skill in preparing reports and answering correspondence.
• Skill in establishing and maintaining effective working relationships with staff and providers.
• Ability to maintain confidentiality of sensitive information.
• Ability to clearly communicate medical coding information and work with others to assure education to providers and their staff, management, coders or Billing Specialists.
• Detailed knowledge of auditing, medical billing, documentation, and coding concepts and principles.
• Strong communication and interpersonal skills.
• Ability to work independently to analyze and solve problems.
• Ability to adapt, modify, and prioritize audit functions as required.
Physical Demands: The physical demands described here are representative of those that may need to 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.
• Requires prolonged standing or sitting.
• Requires frequent bending, stooping or stretching.
• May require lifting up to 50 pounds.
• Requires eye-hand coordination and manual dexterity.
• Requires the ability to distinguish letters or symbols.
• Requires the use of office equipment, such as computer terminals, telephones or photocopiers.
• Requires normal vision range and the absence of color blindness.
Work Environment: The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is performed in an office environment and involves contact with the staff and physicians.