Just like the children we serve, Children's is growing quickly and hiring a Coding Compliance Auditor
to work collaboratively with the Billing Compliance Manager in conducting physician coding audits and providing related training.
Performs coding audits for physicians and advanced practice providers (APPs), such as nurse practitioners and physician assistants, under the direction of the Billing Compliance Manager
- Reviews documentation in Epic to determine if it supports the codes billed.
- Understands documentation requirements for Evaluation & Management (E/M) Services as well as surgical procedures
- Shares individual audit results with each provider with a focus on education and improvement opportunities
- Summarizes audit results by specialty and shares specialty-specific results with the appropriate Clinical Service Chief
Reviews Observation accounts on a daily basis to ensure that Observation Interruption time is appropriately deducted from total Observation hours
Maintains a working knowledge of provider documentation and charging processes. Works with providers, department managers and IT to resolve identified challenges involving Epic, including those related to charge entry, templates, SmartPhrases, WQs and billing edits. Works collaboratively with coders throughout the organization, including those in the CBO, Pediatric Orthopaedics, Pediatric Surgery and HIM.
- Maintains current knowledge of CPT codes, HCPCS (Healthcare Common Procedure Coding System) codes, ICD-10 diagnosis codes, CMS regulations and payor-specific rules to facilitate the documentation, coding, billing and auditing processes.
- Researches and responds in a timely, accurate and professional manner to coding inquiries from physicians, APPs and other internal parties while ensuring the response is consistent with CMS regulations and other relevant payor guidelines
Regular attendance at work is an essential function of the job.
Perform physical requirements as described in the Physical Requirements section
Performs other duties as assigned
KNOWLEDGE, SKILLS AND ABILITIES:
EDUCATION AND EXPERIENCE:
- Knowledge of medical terminology, anatomy and physiology
- Knowledge of CPT, HCPCS and ICD-10 coding
- Familiarity with coding-related reference materials, such as CPT Assistant, Coders’ Desk Reference, Coding Clinic, etc
- Appropriate levels of confidence and composure useful in sharing audit results with physicians and APPs
- Ability to work independently to effectively and efficiently perform assigned tasks
- Ability to type 40 words per minute with accuracy (with spell check)
- High School Diploma or G.E.D. required
- Minimum five years’ experience coding in a hospital, physician office or insurance environment required
- CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or CCS-P (Certified Coding Specialist- Physician-based) certification required