Coding Compliance Job Description

Coding Compliance Job Description

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Coding compliance provides clinical support and assist in the meeting management of the HPHC new technology assessment committee and the clinical medical policy committee.

Coding Compliance Duties & Responsibilities

To write an effective coding compliance job description, begin by listing detailed duties, responsibilities and expectations. We have included coding compliance job description templates that you can modify and use.

Sample responsibilities for this position include:

Maintain knowledge of ICD9 / ICD10 and CPT classifications and coding of diagnoses and procedure
Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding
Develop and assist with educational materials for providers and staff on CPT, ICD-10, HCPCS, and RAF scores, with federal and local healthcare regulations, reimbursement policies and procedures
Reviews AHA and CPT quarterly coding update publications
This position is responsible for researching CPT, ICD-9, Medicare and Medicaid billing rules, and providing appropriate training including presentations with written and verbal communication
Conduct compliance reviews for potential new practices Recruitment has identified and provide results of review
Coordinate the MediSync training for new providers
Conduct and document outcomes for new provider compliance reviews
Conduct and document outcomes for annual Category I and Category II compliance reviews
Provide education on coding compliance issues identified during the review process

Coding Compliance Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Coding Compliance

List any licenses or certifications required by the position: CCS, CIC, CPC, CPMA, EM, E/M, ACS, CMC, CRC, RHIT

Education for Coding Compliance

Typically a job would require a certain level of education.

Employers hiring for the coding compliance job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Education, Health Information Management, Associates, Business, Medical, Communication, Healthcare, Health, Auditing, Business/Administration

Skills for Coding Compliance

Desired skills for coding compliance include:

CPT
Reimbursement systems
Ancillary services
Medical diagnostic and therapeutic procedures
Medical specialties
Clinical Modification
International Classification of Diseases
Medical terminology
Business analysis
Project management concepts

Desired experience for coding compliance includes:

Provide results of compliance reviews to the providers and additional staff, as needed
Coordinate Category III and IV compliance reviews with outside auditor
Conduct focused reviews and document findings after identification of a specific problem relating to inaccurate coding / billing
Run and review Quarterly Reports and conduct follow-up as needed based on the outcome
Coordinate outside Payer audits/reviews and appeals
Attend Practice Implementation Team meetings

Coding Compliance Examples

1

Coding Compliance Job Description

Job Description Example
Our growing company is hiring for a coding compliance. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for coding compliance
  • Conduct new biller training
  • Develop / update curriculum and training handbook as needed
  • Manage Learning Management System (LMS) and web portal content
  • Ensure completion of required LMS modules
  • Maintains all coding credentialing for I-10, HCC and other training and education
  • May participate in payer testing
  • May work with HLI staff and DUHS IT staff to provide data analysis
  • May work collaborative with IMO/MC teams to identify critical language/coding needs
  • Anticipates needs of DUHS regarding I-9/I-10 data analytics, preference list and mappings/crosswalks
  • Provides data and support to the overall coding compliance and audit program
Qualifications for coding compliance
  • Provides program related liaison as needed with entity CDI and quality teams
  • Articulate audit findings appropriate for audience
  • Demonstrated ability to effectively work within a team environment, using excellent written, verbal and presentation skills to share audit findings, risk areas and compliance issues
  • Must be available to work flexible days and hours
  • Travel between all Medical Center facilities may be required
  • Strong interpersonal and excellent written and oral communication skills
2

Coding Compliance Job Description

Job Description Example
Our growing company is looking to fill the role of coding compliance. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for coding compliance
  • Audit medical records according to annual schedule set by the audit team
  • As requested by Director or Manager of Compliance, perform other audits or investigations of various health system operations relative to documentation, billing process, privacy, quality or other functions relating to proper compliance with governmental regulations, laws and policies
  • Report unusual and complex issues and situations to Manager for guidance
  • Responsible for organizing and maintaining coding compliance semi-annual reviews in accordance with Conifer policies and procedures, including managing a team of senior auditors to ensure all appropriate facilities are included in the audit procedure and to ensure appropriate risk-based areas of coding are identified and included in SAR audit samples
  • Fulfills the role of subject matter expert in guiding practices and outcomes in this specialty area
  • This includes obtaining, recording and reporting essential data, assisting in problem solving coding issues and ongoing education of physicians and staff
  • Position also manages projects for updating and training all multi-specialty physician clinics
  • Assist with monitoring daily internal workflow and productivity to insure proper prioritization and timeliness of work, recommending adjustments in coverage as needed
  • Assist management with hiring decisions by assessing the coding skills of applicants applying for coding positions
  • Develop training curriculum and conducts department orientation for new hires
Qualifications for coding compliance
  • Minimum two (2) years of heath care compliance, health care operations (quality, risk, ), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience
  • General application of health care industry practices and standards
  • AHIMA certification RHIT, CCS, or CCA required
  • Expert knowledge of compliance policies, practices and systems
  • Expert knowledge of compliance-related practices and standards
  • Significant compliance orientation, coupled with business process expertise and acumen
3

Coding Compliance Job Description

Job Description Example
Our innovative and growing company is hiring for a coding compliance. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for coding compliance
  • Act as a resource to provider and back office staff Corporate Business Services personnel to answer coding and/or compliance questions
  • Develop and perform new provider orientation on PMC’s coding, audit process and documentation standards
  • Support Clinic Manager in instruction of coding education classes provided to providers, and clinic support staff
  • Review reimbursement denials from third party carriers associated with inappropriate diagnosis or procedure coding
  • Researches and analyzes compliance issues utilizing various publications including extensive use of the internet, the Federal Register, the Medicare Carriers Manual, and other industry publications
  • Monitors regulatory and industry developments regarding audit program requirements and best practices
  • Develop and performsnew provider orientation on PMC’s coding, audit process and documentation standards
  • Responsible for conducting audits of medical records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid and third party billing regulations and/or standards
  • Assists Associate Director in investigating inquires which may relate to erroneous billing and coding of services
  • Works closely with Internal Audit, FGP Compliance, Health Information Management and Patient Financial Services to conduct coding reviews and inquires
Qualifications for coding compliance
  • Manages and is accountable for a team of Optum360 Coding Compliance Audit team, auditing onshore and offshore coders
  • Audit the quality of the auditors to assure quality of audit results and that appropriate education and feedback is provided to coders
  • Be the primary contact for Dignity Health Coding Compliance concerns and will coordinate ad hoc audits
  • Act as the Subject Matter Expert for inpatient and outpatient coding
  • Collaborate with the team and other managers within Compliance, to develop coder and auditor ongoing and periodic education
  • Respond to client audits and other requests and coordinate with operations on implementation of coder Corrective Action Plans
4

Coding Compliance Job Description

Job Description Example
Our innovative and growing company is hiring for a coding compliance. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for coding compliance
  • Understands, interprets and applies coding guidelines for coding audits
  • 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, ) that impact coding accuracy
  • HIM management of RAC, commercial, and external audit/denial/appeal process
  • Works with management and the audit team to execute the annual audit plan
  • Detects areas of billing inefficiencies, internal control weaknesses and noncompliance with departmental and/or company policies/procedure, and applicable laws and regulations
  • Drafts written reports in accordance with reporting standards
  • Monitors audit issue resolution to closure
  • The Compliance Coding Educator/Auditor will function as a resource and educator for UM SJMG providers, and staff in clinical departments, physician practices, and billing staff
  • Interprets changes in the external regulatory environment and stays current with coding updates
Qualifications for coding compliance
  • Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas
  • Assure audit results are clearly and appropriately reported to clients
  • Maintain and updates coding knowledge and coding credentials in order to provide coding policy direction and support to their team of auditors
  • Technical understanding of healthcare and health information industry practices and Electronic Medical Systems
  • Inpatient and Outpatient Coding Guidelines
  • RHIT and CCS certified
5

Coding Compliance Job Description

Job Description Example
Our growing company is looking for a coding compliance. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for coding compliance
  • Develops, implements and monitors Annual Audit workplan including scope and budgeted hours
  • Coordinates/conducts internal compliance investigations and responses to investigations by the OIG, IL-OIG and other governmental agencies
  • Reports compliance concerns to Corporate Compliance Officer as appropriate and in accordance with NorthShore's Corporate Compliance Program
  • Identifies departments or providers that do not meet established coding and documentation compliance targets
  • Compiles and reports quarterly compliance/audit activities for Corporate Compliance Committee and Audit Committee of the Board
  • Identifies inefficient audit processes by analyzing workflows and modifies policies and procedures as required
  • Monitors departmental hours and expenditures, as needed
  • Identifies and procures coding/billing resources and coordinates webinars/seminars as appropriate
  • Abides by all applicable NorthShore policies, procedures and guidelines and assists in the administration of the NorthShore Corporate Compliance Plan
  • Assists the Director with developing and administering the CC Compliance Program
Qualifications for coding compliance
  • AHIMA Approved ICD-10-CM/PCS Trainer strongly preferred
  • RHIA, RHIT and CCS
  • RHIA, RHIT, CCS, CPC, CPC-H, credentials preferred
  • Five to seven years related experience required
  • Knowledge of Microsoft Office Suite including PowerPoint, Excel and Access
  • Must have a minimum of (3) three years coding experience in a healthcare setting

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