Sr Coding Compliance Auditor

Sr Coding Compliance Auditor

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.

The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture.

Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization.

The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level. The Sr Coding Compliance Auditor's primary focus will be to facilitate and ensure the comprehensive capture of chronic conditions for the purpose of accurately reporting HCC's. Prospective and concurrent reviews will account for 70% of the workload with the other portion of time focused on provider communication, and claims denial resolutions. Communicates denial trends to leadership and works with practice managers to resolve these trends.

The position will create and develop sustainable workflows as this will be a new area of focus. Additionally the role will assist with educating providers on quality opportunities as well.

Essential Functions:

• Works to resolve claims denials and reports denial trends to leadership
• Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the patients' chart note.
• Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures.
• Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process.
• Assists in the development and reporting of HCC and Pay for Performance metrics.
• Adheres to deadlines and ensures reports are completed and distributed to all concerned parties.
• Provides structured and ad hoc training / education to staff and providers. Performance necessary analysis of data for the purpose of identifying trends and making suggestions for change to process. Develop action plans based on analysis.
• Works collaboratively with Revenue Cycle Staff, Coding team, Clinical Informatics, and other CommonSpirit staff associated with HCC Initiative.
• Identifies claims correction opportunities and submits to appropriate personnel for processing.
• Acts as documentation and coding liaison to clinicians to include review, education and necessary follow-up to help ensure that clinical documentation and coding services meet government and organizational policies and procedures.
• Performs periodic on-line meetings with assigned offices, to provide documentation education and assist with workflow issues, while building a rapport with practice managers, office staff, and providers.
• Prepares necessary reports and communicates results of audits to management, clinicians, and committees as appropriate.
• Reports areas of risk directly to the Risk Coding Manager/Supervisor.
• Maintains a high level of competency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by attending appropriate workshops and seminars.
• Working knowledge of concepts, practices, policies, procedures, standards, systems and tools applicable to medical records coding; including documentation requirements and medical terminology.
• Possess a strong work ethic with demonstrated ability to work independently or collaboratively as part of a team with multiple priorities and deadline constraints.
• Maintain confidentiality of patient information.
• Participate in departmental projects in order to enhance efficiency, systems, education, patient care or personal growth.

Job Requirements

Required

Coding Certification through American Health Information Management Association (AHIMA) as Certified Coding Specialist (CCS) or Certified Coding Specialist Physician Based (CCS-P) or the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) required.

Preferred

• Professional Medical Auditor Certification (CPMA) (CMAS)-preferred but not required
• CRC Certification preferred or must be obtained within the first year.

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI, CMS, Healthgrades, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards.