US Heart and Vascular is in need of a Remote Coding Compliance Auditor to join our team.
Position Summary: The Coding Compliance Auditor performs internal medical record audits and prepares compliance auditing reports, subsequent educational materials and training as directed by the Compliance and Privacy department.
Audits include regular compliance medical record audits or focused review projects for ongoing review of coding and documentation for cardiovascular specialties to support compliance with coding and documentation rules and regulations.
Responsibilities: • Performs coding audits reviewing for compliance and accuracy with CPT, ICD-10, HCPCS and corporate coding policy and follows up for timely completion within designated time period.
• Maintains excellent documentation of all reviews, methodologies employed, results, corrective actions implemented, and monitoring.
• Assists in focused review projects including data analysis, reporting, and corrective action identification and referral to the Coding Education Department.
• Reports findings of identified trends and risks to the Director of Billing and Coding Compliance.
• Participates in the departmental meetings and provides compliance knowledge and background as required.
• Assists the Director of Billing and Coding Compliance with the development of policies and procedures for the compliance audit program.
• Prepares monthly, bi-monthly, quarterly and annual reports for and as directed by the Director of Billing and Coding Compliance or the Vice President, Compliance and Privacy Officer.
• Establishes and maintains cooperative working relationships with the corporate management team, physician practices and all staff members to provide expertise and compliance training as needed.
• Performs additional administrative duties as assigned by the Compliance and Privacy department.
Requirements: • Certification: Certified Professional Coder (CPC) from AAPC or AHIMA equivalent Certification.
• Certified Professional Medical Auditor (CPMA) from AAPC (required to obtain within 12 months of hire date).
• Minimum of 5 years of experience in medical coding (cardiovascular specialties preferred).
• Minimum of 2 years of experience in medical auditing (cardiovascular specialties preferred).
• Minimum of 2 years of experience in direct provider education.
• Strong knowledge of healthcare regulations, billing practices, and coding standards.
• Experience with compliance audits, investigations, and regulatory reporting.
• Excellent communication, analytical, and leadership skills.
• Bachelor's degree in health care administration, Public Health, Business, or related field preferred but not required.
• Certification: Certified Cardiology Coder (CRC) from AAPC preferred but not required.
• Experience in risk adjustment coding and health plan operations preferred but not required.
• Knowledge of federal, state and local laws, statutes, regulations, codes, and standards related to the area of responsibility.