Coding and Compliance Auditor

Westchester County, NY

Department: Healthcare Finance and Operations Job Number: 5556

Title: Coding and Compliance Auditor

Location: Westchester, NY

Industry: Healthcare

Occupational Category: Healthcare Finance and Operations

Hours: Full-time

Description: Our client, a physician lead practice located in Westchester County, NY, with over 40 office locations throughout New York and New Jersey is looking to hire a full time Coding and Compliance Auditor. The Coding and Compliance Aditor will assist in the evaluation of medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. This individual will also provide guidance and training on medical coding to physicians and staff.

 

The Coding and Compliance Auditor must have knowledge of third party billing procedures across a variety of payer systems and have specific expertise in CPT, ICD-9/ ICD-10 and HCPCS coding for a physician group. Must also have a working knowledge of Evaluation and Management (E&M) coding and can conduct chart reviews using the 1995 and 1997 E&M Guidelines. ? 

 

Responsibilities:

  • Assist in the oversight of compliance program and activities.
  • Assist with establishing compliance policies in accordance with the Company?s compliance strategies and priorities, and applicable laws, regulations, and industry codes.
  • Assist in the monitoring, and as necessary, coordination of compliance activities, to remain abreast of the status of all compliance activities and to identify trends.
  • Audits medical record documentation to identify coding deficiencies of services billed; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
  • Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  • Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
  • Assist in the review, development, modification, and/or adaption of relevant ENTA procedures, protocols, and data management systems to ensure that physician billing operations meets state and local regulations.
  • Review monthly identified refunds as the result of Medical Management Committee activities to verify that a refund has been appropriately processed.
  • Perform analysis of documentation as requested by external inquiries and assist in medical record collection/submission, and appealing findings.
  • Assist in the preparation of educational material training/education sessions.

 

Requirements:

  • Associate?s degree in related field, with Bachelor?s preferred; may be supplemented with two (2) years of related work experience.
  • Coding certification (CPC, CCS, CCS-P, CPMA, CEMC or CENTC) required.
  • Compliance certifications (CHC, CPCO) preferred.
  • Two (2) years coding experience required.
  • Occasional travel to clinical office locations will be required.
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