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Coding Compliance Auditor

Work Schedule/Days:  Day / Monday - Friday
Employment Type:  Full-Time
Location:  Office Park (1711) 
Requisition #:  37781

 

JOB SUMMARY

Performs audits to promote organizational integrity of billing and coding for professional services. Evaluates the accuracy of ICD/CPT/HCPCS and other third-party payor codes. Verifies adequacy of documentation in support of services billed, including teaching physician guidelines, medical necessity, and compliance with other documentation, coding, and billing standards.

EDUCATION
  • College degree or graduate of approved health information technology/health information management program
CERTIFICATION SUMMARY

• One of the following: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), or Certified Professional Compliance Officer (CPCO)

EXPERIENCE*
  • 5 years of experience in healthcare, including 3 years of experience in physician practice coding, documentation, billing, and/or reimbursement
PREFERRED QUALIFICATIONS*
  • Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA)
KNOWLEDGE SKILLS & ABILITIES*
  • Proficient in Microsoft Office, including Word and Excel
  • Experienced problem-solver
  • Demonstrated customer focus
  • Excellent written and verbal communications skills
  • Maintains current knowledge of federal and state regulations and guidelines, CMS and other third-party payor billing rules, and OIG compliance standards
JOB RESPONSIBILITIES*

1. Conducts coding, billing, and documentation compliance audits within established timeframe and in accordance with the standards defined by Children's Healthcare of Atlanta.
2. Prepares a report of findings and recommendations for improvement for each audit.
3. Serves as a subject matter expert on coding/billing topics.
4. Researches issues/questions and responds to internal inquiries.
5. Provides guidance to Education on identified areas of concern and give rationale on application of coding, billing, and documentation rules
6. Assists in audit/coding special projects as needed
7. Identifies trends or potential non-compliant work procedures based on provider chart reviews.
8. Clearly documents information to support findings and rationale.
9. Partners with Education, Coding Ops, and practice leadership on application of rules and regulations in accordance with Children’s standards while coordinating review of open issues until resolved
10. Provides appropriately messaged and continuous updates to practice leadership and Education regarding audit status
11. Researches new regulatory requirements for each specialty and applies updates annually
12. Required to participate in monthly webinar education specific to Coding Audit
13. Reviews and analyzes prior year Coding Education to ensure guidance is aligned with rules and regulations and identify potential opportunities to improve physician education
14. Meets audit productivity standard.
15. Meets annual requirements to maintain coding certification.

SYSTEM RESPONSIBILITIES*

Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.

 

Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.

 

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification.  They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.

PHYSICAL DEMANDS*
Bending/Stooping - Occasionally (activity or condition exists up to 1/3 of time)
Climbing - Occasionally (activity or condition exists up to 1/3 of time)
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Frequently (activity or condition exists from 1/3 to 2/3 of time)
Standing - Occasionally (activity or condition exists up to 1/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
WORKING CONDITIONS*
Some potential for exposure to blood and body fluids

 

About Us:

Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children’s is dedicated to making kids better today and healthier tomorrow.

With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News & World Report.

Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for fourteen consecutive years and named one of the “100 Best Companies” by Working Mother magazine.  We offer a comprehensive compensation and benefit package that supports our mission, vision and values.  We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country.  Connect to our mission of making kids better today and healthier tomorrow. 

Have questions about the recruitment process?  Check out What to Expect.

Address:  1711 Tullie Circle, Atlanta, GA  30329
Function:  Revenue Cycle - Coding


Nearest Major Market: Atlanta

Job Segment: Medical, Medical Coding, Pediatric, Healthcare