Coding Compliance Auditor
The Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community Health System's mission to better the lives of all those we serve. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation audits to ensure accurate code assignment, appropriate billing, integrity of the medical record, and compliance with federal and state healthcare program requirements.
The role requires a highly confident coder who can audit both facility coding and professional fees for partners, as well as audit other coders and physicians.
Qualifications
Education:
- Associate's Degree in Business, Information Systems, Nursing, Health Care, or a related field required
- Bachelor's Degree in Business, Information Systems, Nursing, Health Care, or a related field preferred
Experience:
- Experience performing medical record and billing audits/reviews, including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM, and revenue), and reviews for charge and reimbursement accuracy required
- Knowledge of federal, state, and private payer guidelines required
One of the following is required:
- 5 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS, if qualifying with an Associate's Degree
- 3 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS, if qualifying with a Bachelor's Degree
- Epic experience preferred
- Experience with 3M or Optum is preferred
- Experience completing a formal validation report after completing audits preferred.
Licenses and Certifications:
- One of the following is required:
- CCS - Certified Coding Specialist
- CCS-P - Certified Coding Specialist- Physician-based
- CMAS - Certified Medical Audit Specialist
- CPMA - Certified Professional Medical Auditor
- CPC - Certified Professional Coder
- Additional certifications preferred:
- RHIA - Registered Health Information Administrator
- RHIT - Registered Health Information Technician
- Two or more certifications preferred
Disclaimers
Pay ranges listed are an estimate and subject to change. If any bonuses are noted, they are only applicable to external hires meeting criteria.