Job Description
Position Summary: The Coding Compliance Analyst must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations & guidelines, benchmark standards and must have a high level of analytical and statistical skill sets in order to monitor the systems for data quality and integrity across the various functional applications. The Coding Compliance Analyst position is responsible for running reports for coding, auditing, analysis review, trending, tracking purposes and coding compliance project management in conjunction with department initiatives. Additionally, responsible for maintaining Coding Compliance integrity of master files, claims, custom rules and worklist dashboard.
Essential Job functions:
Coding Compliance Review Project Management
Under the direction of the Senior Analyst and/or Director, the Analyst assists in the management of the Auditor's workflow, custom rules, coordination of medical records that are needed for audits, ensures timely completion of projects, educational reviews, baseline reviews, new provider reviews, etc.
Assists Senior Analyst and/or Director with project management of Provider focused compliance audit reviews as outlined in Coding Compliance Education Plan, ensuring Auditors are completing reviews timely and final reports are comprehensive and communicated timely.
Develops, maintains and implements tracking and reporting mechanisms related to compliance initiatives and activities.
Coordination of process for correcting claims accordingly based on final audit review, releasing only compliant claims for billing and management of other claims that require additional review.
Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates data-mining and analysis where appropriate and alerting the Director of any areas of concern.
Demonstrates the ability to project manage, makes decisions & delegates responsibility to ensure high quality performance & efficiency.
Coding Compliance Custom Rules/Claims Management (A/R)
Regularly monitors claims management through reporting the status of compliance projects, audits and claims on hold to ensure timely follow-up and filing of claims.
Utilizes practice management system and other system applications to run reports on payer claim activity and designated areas of review.
Assists with ensuring that compliance custom rules and master files are up to date in the practice management system, by maintaining and/or working Coding Compliance Worklist/custom rules.
Coding Compliance Initiatives -- Tracking/Report Analysis
Assists in development of baseline, new provider and focused reviews -- Coding Compliance dashboards.
Run reports for Coding Compliance Department, Management Team and physicians as needed to communicate data of interest, work performed or ad hoc.
Prepare written reports of analysis and audit findings along with bell curves, graphs, etc. in order to present to Director, Physicians or other parties.
Assists/performs audit reviews for risk assessment purposes or as needed to complete benchmarks.
Exhibit strong research skills including knowledge of automated analysis tools and online research tools to conduct research on assigned issues.
General Job functions:
Assists Coding teams with various documentation related projects.
Assists on special projects as required.
Ability to work independently as well as in a group setting.
Ability to work a flexible schedule to meet the needs of SMG and SHM.
Environmental Risks:
e. Extreme temperature
Benefits*
A friendly and fast paced environment working with passionate people
Outstanding growth opportunities
Paid Time Off
Medical, Dental and Vision Insurance
Short/Long Term Disability, HSA and Life Insurance
401K plan with company matching contribution (after 90 days)
Cash Bonus Programs
Opportunity for Overtime hours
Recognition and rewards programs to recognize successful teams
Other Perks & Discounts
Commuter and parking discount program to help you save (using pretax dollars)
*Full Time Benefit Eligible Employees Only
Equal Opportunity Employer
Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.
Safety Disclaimer
Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.