Compliance Coder/Auditor

SUMMARY:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required for this position. Reasonable accommodations may be made, upon request, to enable individuals with disabilities, who otherwise meet the qualifications, to perform the essential functions of the position.

SUMMARY OF DUTIES:

Under the general direction of the Compliance Audit Manager, is responsible for conducting prospective and retrospective audits of medical record documentation to assess billing and coding compliance with Brown Medicine policies and federal and state regulations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Consistently applies the Brown Medicine values of patient care priority, dignity, collaboration, integrity and quality in support of the Brown Medicine mission to deliver compassionate, high-quality patient care, research excellence and outstanding physician education. Is responsible for knowing and acting in accordance with Brown Medicine Confidentiality and Code of Conduct policies.

• Reads and interprets health record documentation to identify all diagnoses and procedures that affect the inpatient/outpatient stay/visit.
• Conduct prospective and retrospective medical record reviews to ensure appropriate coding and documentation for both inpatient & outpatient services
• Report findings, and communicate audit results to Providers as appropriate
• Perform follow up audits for Providers based on audit results.
• Identify areas for documentation improvement and recommend additional education resources for Providers
• Draft reports of findings and recommendations to assist educators/audit manager working with Providers
• Maintains organization-wide audit queue to track courtesy, annual, and audit follow-up frequency and due dates.
• Responsible for maintaining current knowledge of coding and documentation guidelines.
• Complies with established departmental policies, procedures, and other objectives.

KNOWLEDGE, SKILLS & ABILITIES REQUIRED:

• Current and thorough knowledge of coding classifications with a focus on E&M codes

• Strong organizational and communication skills required.
• Exercise a high degree of initiative, judgment and discretion.
• Analyze situations accurately and take effective action.
• Establish and maintain effective communications with a variety of professional and nonprofessional staff.
• Identify, report and assist in analysis and reporting of special audits.
• Evaluate, make recommendations, and implement guidelines, policies and procedures.

EDUCATION AND EXPERIENCE:

Certified Professional Coder (CPC) and (CEMC) Certified Evaluation and Management Coder (CEMC). (CEMC may not be necessary if candidate has prior E&M auditing experience)

Minimum of one-year prior coding experience. Experience in EM coding/auditing preferred. Experience in Dermatology a plus.

EOE/F/M/Vet/Disabled