Hospital Coding Compliance Auditor

Emory Healthcare•Tucker, GA

12h•Onsite

About The Position

Reporting to the Manager, Compliance Audit and Analysis, develops and executes audit, monitoring, and education for inpatient hospital billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluates inpatient hospital/clinical billing compliance activities to assess compliance with the Compliance Audit and Analysis Program and appropriate focus on risk areas. Serves as a resource for providers and caregivers on hospital/clinical billing and coding.

Requirements

Bachelors degree required.
Clinical background preferred (i.e., LPN, RN, etc.).
Current Certified Coding Specialist (CCS) certification required.
Certification in Healthcare Compliance required.
Minimum of three (3) years of experience with either inpatient or outpatient audit activities, required.
Proficient in MDAudit Enterprise software and Epic electronic health record systems.
Thorough knowledge of coding documentation improvement practices.
Thorough knowledge and understanding of hospital inpatient billing, coding, and documentation requirements, Federal and State regulations, medical necessity, clinical best practices, and hospital/clinical billing issues.
Project management experience preferred
Knowledge of legal, regulatory, and policy compliance issues related to coding, billing, procedures, and documentation.
Ability to clearly communicate coding information, including the results of coding compliance audit activities.
Proficiency in root cause analysis, critical thinking, and gaining acceptance of recommended solutions.
Team player and understands role in relationship to others. Strong interpersonal and communication skills.
Clear, concise, and persuasive writing and presentation skills.
Strong orientation to deadline and detail.
Strong organizational and project management skills.
Working knowledge of computer software Word, Access, Excel, PowerPoint; as well as EMR.
Knowledge of healthcare financial management principles/practices.
Ability to work in highly matrixed environments.
Ability to be flexible and adapt to change.

Nice To Haves

Clinical background preferred (i.e., LPN, RN, etc.).
Project management experience preferred

Responsibilities

Prepares and oversees inpatient hospital/clinical billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
Leads focused audits and reviews to investigate adherence with inpatient hospital/clinical billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
Assists in development of organizational compliance auditing and monitoring activities for hospital/clinical billing and coding, including periodic reviews of the individual department auditing and monitoring functions.
Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate documentation.
Creates audit result reports to be reviewed with providers.
Organizes and schedules audit findings/education sessions with providers to review audit results.
Conducts trend analyses to identify patterns and variations in inpatient hospital/clinical billing and coding practices that indicate areas of heightened risk.
Serves as primary lead for inpatient hospital/clinical billing compliance education including auditing, trending, and feedback to hospital inpatient coders and providers working in the hospital setting, as applicable.
Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers.
Leads training on proper documentation for inpatient hospital/clinical billing and coding compliance.
Works with the compliance operations, billing team, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.
Evaluates training methods and modalities and works with relevant departments to implement.
Ensures required provider compliance training related to inpatient hospital documentation, coding and billing is completed on time and in accordance with compliance program policies.
Provides counseling, education and/or recommended disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to hospital/clinical billing compliance.
Recommends corrective action plans if necessary to address deficiencies identified by auditing and monitoring activities for specific inpatient services, or on an organization-wide basis.
Conducts audits and manages findings of audits or other reviews in MDAudit, and works with the Manager, Compliance Audit and Analysis, if issues need to be entered into the departments issues tracking modality.
Maintains required credentials, participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e., conferences, workshops, and other professional development activities).
Maintains confidentiality of patient/members and staff information.
Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
Performs other related duties as required.