Compliance Coding Auditor

Overview

Compliance Coding Auditor role at Sharp Health Care.

Hours:

AWS Hours Requirement: 8/40 - 8 Hour Shift. Shift Start Time:
Variable. Shift End Time:
Variable. Weekend requirements:
No weekends. On-call:
No. The stated pay scale is $48.140 - $62.110 - $76.080, with actual pay dependent on factors including experience, skills, education, and internal considerations.

The role supports Sharp Health Care's compliance audit program, focusing on coding, billing, and reimbursement audits to prevent and detect violations and promote compliant practices.

• Administer Sharp Health Care’s compliance audit program and oversee high-quality coding, billing, and reimbursement audit activities.
• Provide oversight of the coding, billing, and reimbursement compliance audits and report findings to stakeholders; propose corrective actions as needed.
• Review electronic health records to identify potential coding and billing compliance issues and prepare written audit reports with recommendations.
• Analyze and assess Sharp’s potential risks using billing and coding data, risk assessment data, and external sources (e.g., OIG Work Plan, CMS, PEPPER, RAC Denials, industry guidance).

• Coding and Billing Audits:
  Perform audits and chart reviews for inpatient and/or outpatient coding and billing; conduct daily retrospective chart reviews and communicate findings; monitor for compliance issues and advise on corrective actions.
• Policy and Procedure Maintenance:
  Work with the Director and Manager of Compliance to develop standardized documentation, medical necessity, coding, and billing policies in line with laws and internal policies.
• Professional Development:
  Maintain current ICD-10-CM/PCS, DRG, CPT, and HCPCS knowledge; stay updated on regulatory changes and complete ongoing education.
• Unit Support:
  Support key stakeholders with inpatient/outpatient coding and billing inquiries; monitor documentation quality and physician queries to improve coding accuracy; maintain professional relationships and effective communication skills.
• Certification:
  Certified Clinical Documentation Improvement Practitioner or CCDS is required within 1 year of hire; management tracks certification progress.

• Required:
  
  Bachelor’s degree in Business, Healthcare Administration, or related field. In lieu of a bachelor’s, an Associate’s degree plus a minimum of 5 years of coding, billing, and compliance experience may be considered.
• One of the following certifications: AHIMA CCS or CDIP, or AAPC CIC or CPC. CDIP or CCDS certification is preferred to be achieved within 1 year of hire.

• Strong background in ICD-10-CM/PCS, DRG, and CPT coding.
• CCDS or CCDS certification is preferred.
• Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) - preferred.

• Ability to perform independent research and analyze coding and billing matters; propose root-cause solutions.
• Proficiency with Microsoft Office and ability to operate in a fast-paced environment.
• Excellent time management, problem solving, and analytical abilities; strong written and oral communication; teamwork and flexibility.

Sharp Health Care is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, veteran status, disability, or other protected status.