Job Description
Job Description Summary The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements. Job Description Job Responsibilities: Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Responsible for conducting both routine and targeted audits to ensure clinical documentation supports accurate CPT, HCPC’s, PCS and ICD-10-CM codes. Perform prospective and retrospective audits to validate medical necessity and documentation supportive of code selection. Analyzes data to identify deficiencies, prepare reports to deliver provider education specific to training needs identified during audit. Develop and monitor follow-up audits and education as determined necessary to improve documentation quality. Support all departments of the Health System with coding guidance: Pertaining to compliance training / education as requested from providers and/or staff related to coding, billing and documentation in the inpatient, outpatient, professional, surgical and Home Health divisions of the Health System to ensure accuracy and support program objectives. Designs training programs around compliant coding and billing from a regulatory standpoint for any new initiatives or programs affecting the Health System. Evaluates vendor-training materials for its application or recommendation for use in educational programs. <