Coding & Documentation Compliance Auditor
Hartford HealthCare Corp.•Hartford, CT
•Onsite
About The Position
The Coding & Documentation Compliance Auditor contributes to the success of the Office of Compliance and Integrity (OCI) by executing clinical documentation, coding and billing audits as assigned or scheduled. The Coding & Documentation Compliance Auditor performs independent reviews to assess compliance with federal, state and private payor regulations, guidelines and requirements. Documentation and coding audits may include professional, facility (inpatient and outpatient), home health and skilled nursing facilities.
Requirements
- Bachelor’s Degree Required
- A minimum of two (2) years of health care compliance experience, preferably in a large Healthcare system setting or in a consulting capacity.
- Experience performing provider documentation and coding audits
- Hands-on auditing of E/M services and professional claims
- Experience validating charges against medical records
- Strong knowledge of Medicare/Medicaid, CPT, and ICD-10
- Experience in physician billing or revenue integrity
Nice To Haves
- Certified Professional Coder (CPC) certification strongly preferred
Responsibilities
- Conducts audits in accordance with the approved Revenue Compliance Work Plan or as requested by the Manager or Director.
- Maintains organized files to support audit observations and drafts related audit reports in accordance with agreed upon standards in a timely manner.
- Collaborates with business owner to develop agreed-upon action plans to address findings identified during an audit.
- Communicates audit results and corrective action plans to audit stakeholders. Monitors progress of corrective actions and provides status reports to leadership. Independently validates that corrective action plans are implemented as intended.
- Stays up to date on documentation, coding and billing regulations and requirements via professional organizations and through independent research and education on payor rules, requirements and regulatory guidelines (HHS/OIG, Medicare, Medicaid, NGS, Commercial Insurers, etc).
- Assists with review and/or investigation of Compliance Line reports as requested by the Manager or Director.
- Assists with the development and revision of HHC and Department Policies and Procedures.
- Participates in the annual and ongoing risk assessments to develop and revise the Revenue Compliance Work Plan.
Benefits
- competitive benefits program designed to ensure work/life balance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
