Coding Compliance Auditor - Coding Services Non-Exempt; Non-Union

Job Summary

In accordance with current federal coding compliance regulations and guidelines, the Coding Compliance Auditor performs 2nd level review of previously coded accounts to ensure appropriate CPT, ICD-10-CM, and HCPCS assignments – and accuracy and completeness of all ICD-10-CM, CPT, and HCPCS codes assigned by professional revenue coders and providers. All assigned codes must be supported by professional documentation contained within the medical record and must be in compliance with federal coding compliance regulations, Official Coding Guidelines, AHA Coding Clinic, and CPT Assistant.

The Coding Compliance Auditor will also provide detailed reports, Excel spreadsheets, coding audit summary analysis, and data analytics regarding coding accuracy rates, compliance rates, denial analytics, etc. Recommend education topics based on audit findings and assist in the continuing education of professional coders and providers. Understands coding/billing computer systems such as Cerner, Medi Tech, Epic, and Athena IDX in a manner to assure clean claims release for billing in a timely manner.

Participate in response to inquiries regarding coding and documentation from coders, providers, and all other hospital staff. Perform other coding department related duties as assigned by Coding management.

• CODING AUDITING

  1. Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a required coding accuracy rate.

  2. Develops monitoring/education plans for coding staff who do not meet the required accuracy rate.

  3. Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.

  4. Ability to act as a resource to coding staff, USC Care staff, and providers on coding issues and questions.

  5. Ability to achieve a 95% accuracy rate as determined by an annual external review of coding.

• UNDER GENERAL SUPERVISION, RESPONSIBLE FOR

  1. Professional coding of all diagnostic and procedural information from the medical records using ICD-10-CM, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.

  2. Works cooperatively with Coding Support and/or CBO, in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.

  3. Attendance, punctuality, and professionalism in all Coding and work-related activities.

  4. Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications, and actions. Completes tasks accurately, legibly, and in a timely fashion.

  5. Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.

• TIMELINESS OF AUDITING/CODING & PRODUCTIVITY

  1. Maintains at minimum, expected productivity standards, and strives to maintain a steady level of productivity and provides consistent effort.

  2. Works coding queues/task lists to ensure charges are released within defined timelines.

  3. Assist other coders in performance of duties including answering questions and providing guidance, as necessary.

  4. Assist Billing department, USC Care coding department, and other departments in addressing coding issues/questions and/or providing information so that an charges can be generated. Assist physicians, APPs, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed.

  5. Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority.

• POLICY & PROCEDURES; PERFORMANCE IMPROVEMENT

  1. Consistently adhere to coding policies and procedures as directed by Coding management.

  2. Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed.

  3. Participates in continuously assessing and improving departmental performance.

  4. Ability to communicate changes to improve processes to the director, as needed.

  5. Assists in department and section quality improvement activities and processes (i.e. Performance Improvement).

• COMMUNICATION

  1. Works and communicates in a…