General Summary:

The Coding Compliance Auditor – Physicians Practice, utilizing a strong coding background and clinical knowledge, will perform physician documentation and coding audits, facilitate education to support the potential to prevent loss of revenue, optimize charge capture, and adhere to all compliance standards for physicians practice.

The Coding Compliance Auditor – Physicians Practice will consistently demonstrate support of the SRALAB statement of Vision, Mission and Core Values by striving for excellence, contributing to the team efforts and showing respect and compassion for patients and their families, fellow employees, and all others with whom there is contact at or in the interest of the institute.

The Coding Compliance Auditor – Physicians Practice will demonstrate SRALAB Core Attributes: Communication, Accountability, Flexibility/Adaptability, Judgment/Problem Solving, Customer Service and SRALAB Values (Hope, Compassion, Discovery, Collaboration, & Commitment to Excellence) while fulfilling job duties.

Principal Responsibilities:

The Coding Compliance Auditor - Physicians Practice will:

• Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
• Assist the compliance officer in assigned projects from internal or external sources.
• Perform assigned Medicaid, Medicare, and other third party payer audits.
• Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
• Assist in coding outpatient records as needed.
• Provide coding training and updates for coding staff, physicians and clinics as assigned.
• Assist in coordination of the compilation of data relative to regulatory agencies and the accreditation process.
• Review charge master updates and additions for appropriate current ICD-10 and CPT code assignment.
• Supports continuous quality improvement efforts and performs special projects, training, education, and/or duties as assigned by the Manager of Physicians Practice and/or the Director of Medical Records.

Reporting Relationships:

• Report directly to the Manager, Physicians Practice

Knowledge, Skills & Abilities Required:

• Coding Certification through AHIMA or AAPC for Inpatient or Outpatient coding. (i.e., RHIA, RHIT, CCS, or CCS-P certification) and maintains continuing education requirements.
• 1-2 Years of ICD-10 and CPT coding experience and clinical knowledge minimally.
• Knowledge of regulatory, billing, and other coding guidelines.
• Thorough knowledge of related prospective payment systems.
• Auditing skills for coding quality and compliance.
• Advanced computer skills, PC-experience with Windows based applications.
• Interpersonal skills necessary to effectively communicate with other departments, physicians, outside agencies, and key customers. Good writing skills to create reports and ability to graphically present audit data. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.