Compliance Coding Auditor

Compliance Coding Auditor

Job Title Compliance Coding Auditor
Requisition Number 11-1732
Organization Beth Israel Deaconess Medical Center
Division - Department 01080260 - OFFICE OF BUSINESS CONDUCT
Job Category Professional & Management-MGT
City Boston
State MA
Grade 09
Status Full-Time
Shift Day
Position Details Coding Auditor is responsible for performing, completing and summarizing and documenting compliance related hospital documentation and coding audits as per the Compliance Audit Methodology, and assigned and prioritized by the Compliance Audit Workplan and/or the Compliance Audit Manager. Promotes Compliance and Privacy best practices and solutions.
Job Description
* Performs routine compliance audits of hospital inpatient and outpatient documentation, coding and billing in accordance with the Compliance Work Plan in order to assess compliance with Medicare and other third party coding and billing requirements.
* Demonstrates knowledge of the various payment methods for inpatient and outpatient hospital services.
* Assists as requested with responses to government or other external audit or investigative requests.
* Prepares draft reports based on audit procedures and findings, making recommendations for improvement that are supported by Medicare guidance and other appropriate references.
* Determines charge corrections and refunds resulting from compliance audits.
* As requested, develops materials for use in education and communication derived from audit findings for feedback to clinicians, coders and/or billing staff. May provide education regarding documentation, coding and billing practices.
* Provides input in the development and improvement of procedures used to complete the audit function.
* Serve as a content expert and resource for department managers, staff, physicians, and administrative personnel for information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
* Research topics, assimilate information, and communicate effectively in person and in writing.
* Ability to work in a self-directed team by taking and giving direction and sharing in the responsibility of the team.
* Maintains licensure or certification by participating in continuing education; provide management with a copy of certification documents on an annual basis.
Qualifications
* Three or more years experience in a hospital compliance/internal audit department or with a public accounting/consulting firm performing coding auditing.
* Five or more years recent experience in hospital inpatient and/or outpatient coding (i.e. MS-DRG, APC, ICD-9/HCPS/CPT, etc.) and reimbursement principles.
* Must demonstrate knowledge of coding to perform this role and ability to follow standard practices in coding and reimbursement. Also significant exposure to healthcare compliance concepts and compliance auditing.
* Experienced in researching Federal and State coding and reimbursement guidelines and regulations.
* Microsoft Excel & Word intermediate level of experience is required.
* Position Requirements: At least one of the following, RHIA, RHIT, Certified Professional Coder - Hospital (CPC-H) or RN with a Certified Coding Specialist (CCS) certification.
* Education: Associate's degree with three years of relevant experience or a Bachelor's degree with one year of relevant experience or a minimum five years of billing, coding or documentation audit experience in a health care organization is required.