Coding and Compliance Internal Auditor I - CPC

Responsible for coding quality audits of all records (outpatient, inpatient, procedures, testing) to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines and provide ongoing feedback and analysis of the education needs for the providers and staff; also responsible for assisting with coding inquiries from providers, charge posters, billing staff, etc.


Principal Accountabilities:

Coordinates, schedules, performs the professional services documentation and coding audits of outpatient, inpatient, procedures and testing records for physician practices.

• Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported
• Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines
• Responsible for maintaining up to date knowledge of coding guidelines as they relate to professional services.
• Develop and coordinate educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates.
• Evaluates and provides appropriate documentation for the third party payer CPT denials to maintain the original CPT assignment, and when necessary, implement corrective action plan and/or educational programs to prevent similar denials and rejections from recurring.
• Meets with the providers to review the audit findings and to recommend ways to improve when indicated
• Orients and trains new providers throughout the year
• Audit charts for accurate and correct coding and compliance within documentation guidelines and AHS policies
• Prepares written reports of the audit findings by provider/practice
• Follows up with providers as needed until documentation improves
• Assists with claim denial reports to ensure optimal reimbursement
• Serves as a resource to the office staff, providers, and billing department
• Provides clarification on coding and compliance policies