A Brief Overview The Coding Compliance Analyst performs complex professional and /or facility coding and documentation audits based on assigned specialties and/or locations of the Health System in accordance with government and commercial payer guidelines to assess and monitor the accuracy of billing and coding as determined by data analysis of national benchmarking.
Perform reviews of internal data reports to identify areas of coding and documentation risk that need to be audited and reviewed to ensure the organization aligns with governmental billing, coding, and documentation standards. Plans and conducts routine and moderately complex compliance audit reviews including chart audits to evaluate the accuracy of medical codes assigned to patient services documented in a medical record and identify appropriate remedial or corrective actions.
Performs auditing and monitoring of assigned coding and documentation related materials to ensure materials comply with governmental with applicable laws, regulations, and contractual obligations. Researches and develops compliance tools and resources for internal use and publication by employees or team members Serve as a team member and assist on UH initiatives, as needed. Partners with employees, providers, medical staff, and management to review the audit results and identify corrective or remedial actions to address any audit findings.
Participates in the annual risk assessment process in order to identify risks and potential audits for inclusion in the annual work plan. Drafts remedial or corrective action plans and verifies that identified risks have been mitigated. Works with department leadership to identify and implement improvements to Compliance & Ethics Department processes and leads assigned process improvement projects.
Prepares clear, concise, and accurate documentation and records in a timely manner and according to departmental guidelines. Prepares written findings and recommendations in a logical, clear, and concise manner. Creates and delivers coding and documentation to prevent, mitigate, and remediate risk.
Additional Responsibilities Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Education Associate's Degree (Required) Bachelor's Degree (Preferred) Work Experience 5+ years related experience in physician coding and/or auditing (Required) 1+ years related experience in provider education (Required) Knowledge, Skills, & Abilities Detail-oriented and organized, with good analytical and problem solving ability.
(Required proficiency) Notable client service, communication, presentation and relationship building skills. (Required proficiency) Ability to function independently and as a team player in a fast-paced environment. (Required proficiency) Strong written and verbal communication skills.
(Required proficiency) Demonstrated ability to use PCs, Microsoft Office 365, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency) Licenses and Certifications Certified Professional Coder (CPC) (Required) or Certified Professional Coder (CPC) CPC-H (Required) or Certified Coding Specialist (CCS) CCS-P (Required) and Registered Health Information Administration (RHIA) (Required) or Registered Health Information Technologist (RHIT) (Required) CEMC - Certified Professional Coder in Evaluation and Management Coding (Required within 6 Months) Physical Demands Standing Occasionally Walking Occasionally Sitting Constantly Lifting Rarely 20 lbs Carrying Rarely 20 lbs Pushing Rarely 20 lbs Pulling Rarely 20 lbs Climbing Rarely 20 lbs Balancing Rarely Stooping Rarely Kneeling Rarely Crouching Rarely Crawling Rarely Reaching Rarely Handling Occasionally Grasping Occasionally Feeling Rarely Talking Constantly Hearing Constantly Repetitive Motions Frequently Eye/Hand/Foot Coordination Frequently Travel Requirements 10%