Job Description
About the position Responsibilities • Conducts regularly scheduled compliance reviews for assigned providers within designated time frames. • Performs reviews of clinical documentation to verify accuracy of CPT/HCPCS and ICD-10 codes and modifier assignments. • Provides written report of findings to the provider and select administrative personnel along with recommendations for improvement. • Monitors regulatory and reimbursement information to keep informed of relevant changes and updates. • Performs special demand audits as requested or noted in compliance or audit work plans program. • Educates providers one-on-one or in a group setting based on need or as a result of an audit. • Provides oversight and quality assessment of audit and other work of Medical Group Compliance Auditors as well as peers. • Maintains effective communication with department staff as well as key stakeholders and consistently demonstrates high standards of professional conduct and ethics, as well as appropriate judgment, independence, and discretion. • Performs other duties as assigned. Requirements • High School Diploma or equivalent. • 5 years of experience. • One of the following certifications: Certified Professional Coder (CPC) or Certified Coding Specialist (Physician-based) (CCS-P). Nice-to-haves • Any additional certifications such as Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA). Apply tot his job Apply tot his job