Coding & Documentation Compliance Auditor

Hartford Healthcare • Hartford, CT

1d

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level