Job Summary: The coding compliance Director monitors provider E/M profiles and conducts audits and education to ensure appropriate reimbursement and compliance with all regulatory guidance. This position is responsible for identifying compliance issues and analyzing practice patterns and recommending changes to policies and procedures. The coding compliance Director supports the implementation of necessary changes with clinical departments through education of providers and staff. The coding compliance Director maintains the accuracy and completeness of provider audits in the auditing software application. This position meets regularly with the Manager of Coding and Billing Compliance to ensure risks are identified and prioritized across the revenue cycle function.
Minimum Job Qualifications:
Minimum five years of medical billing & coding along with reimbursement experience, in a physician billing environment.
Coding certification through AHIMA (CCS, CCS-P) or the AAPC (CPC) required. Certified Professional Medical Auditor (CPMA) or Association of Healthcare Auditors & Educators (AHCAE) preferred or to be achieved within 12 months of hire.
Essential Tasks and Responsibilities:
Works collaboratively with coding staff and physicians to maintain optimal coding process.
Trains newly hired Coding Specialist/physicians in complete coding job function. Mentors coders/physicians once they are completed with formal training. Informs appropriate management regarding the progress of training audits and any issues.
Audits/Identifies documentation for appropriate procedure and diagnosis code(s).
Audits/Identifies appropriate insurance code, provider code, modifier/s and correct downcoding.
Identifies problems with medical charts, insurance codes, fees, CPT4, ICD9 codes and initiate corrective action. Analyzes clinical information to identify areas within the medical record for potential gaps in physician documentation.
Performs 100% chart audits and performance evaluations during the initial training period as needed.
Actively researches carrier coding issues. Participates on system audit and compliance committees.
Reports physician and coding preformance as appropriate to the compliance committee.
Performs monthly coding in-services as needed.
Assists with Compliance and HIPAA company training.
Develops training program and manuals as needed.
Manages and maintains coding hotline for physician and coding questions.
Supports and leads ICD10 training and audit work.
Prepares audit reports as needed.
Develops and maintains coding procedures.
Responsible for coordination of external audit work.
Monitors ICD-10 Compass reports and provide follow up education support to physicians and leadership
Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.