Auditor, Coding Compliance

Coding Compliance Auditor

Conducts risk-based coding compliance audits of surgical hospital (facility) encounters to validate code assignment is in compliance with the official coding guidelines, as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.

Essential Duties and Responsibilities:

Include the following. Others may be assigned.

• Understands, interprets, and applies inpatient and outpatient coding guidelines for coding audits. Audits surgical hospital encounters diagnosis and procedure code assignments. Review medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM and ICD-10-PCS codes, CPT’s, and HCPCS codes, which all impact facility reimbursement.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.

Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and ICD-10-PCS, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, ICD-10-PCS, HCPCS and CPT updates) for inpatient and outpatient coding (e.g. OPPS, IPPS) coding. Reviews AMA, CMS, and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates

Minimum Qualifications:

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Three (3) years coding experience including, but not limited to, inpatient and outpatient encounters
• One (1) year of experience in coding audit or quality review work including, but not limited to, inpatient and outpatient encounters

AHIMA certification with CCS

Compensation

• Pay: $63,648-$101,504 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

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