Job details

Coding and Compliance Auditor/Educator

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Overview

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Responsibilities

This position provides the opportunity to be responsible for reviewing medical record documentation making sure that the CPT, ICD-10 and HCPCS codes and modifiers are correct for the selected claims. The Auditor will follow Northside policy and procedure for annual audit schedules for both physicians and practices. The Auditor is responsible for completing professional reports of their findings and delivering those results to physicians and leadership.

PRIMARY DUTIES AND RESPONSIBILITIES

Interprets and reviews medical record documentation to make sure the accurate ICD-10, CPT, HCPCS and assigned based on provider documentation.
Expertise in auditing using both the 1995 and 1997 E/M CMS Guidelines
Provides education to providers, practice staff, and coders as needed based on audit results.
Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II and CMS guidelines.
Demonstrate expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem solving skills.
Maintains an accuracy rate of 90% or above for all work Quality Assurance reviews.
Complete assigned work in a timely manner and maintain departmental production standards.
Maintain open communication with Auditing Supervisor.
Proficient in public speaking, presentations, and educational activities Advanced knowledge of medical terminology, CPT and ICD-9-CM and HCPCS coding, Medicare, Medicaid and commercial insurance procedures
Ability to communicate both verbally and in writing with co-workers as well as physicians. Demonstrated ability to explain complicated coding and compliance concepts.
Knowledge of Medicare and Medicaid policies required.
Must maintain a professional appearance and demeanor while working with physicians
High degree of accuracy and attention to detail Ability to work well under little guidance
Objective and detailed approach to problem solving
Good investigative and organizational skills
Extensive experience and knowledge of inpatient and outpatient coding, billing and documentation requirements in large hospital systems
Advanced knowledge of medical records procedures and of federal and state laws governing medical records privacy and release of information
Skill in exercising initiative, judgment, and decision-making to achieve organizational objectives Skill in establishing and maintaining effective working relationships with physicians and staff
Ability to maintain confidentiality of sensitive information
Assist the Revenue Cycle Support Coordinator in setting prices for services and performing market rate studies.
Assists Coordinators in Decision Support with other projects involving an analysis of patient charges and chart documentation using various clinical and financial systems to improve clinical benchmarking and revenue cycle activities.

Qualifications

REQUIRED:

B.S. degree in Nursing, Health Information Management, Healthcare Administration, Business Administration. Relevant years of work experience in the range of 8 - 10 years may be substituted for a B.S. degree.

Must have a coding or nursing credential (RHIA, RHIT, CPC, CCS, RN) or a financial background.

Must have minimum of 1 year hospital and/or physician practice coding experience.

Demonstrated communication skills and an ability to work independently and deal effectively with various types of personnel.

Knowledge of Microsoft Office products.

PREFERRED:

Certified Professional Medical Auditor (CPMA).

Three to five years' experience in a hospital and/or physician practice setting.

Work Hours:

8-4

Weekend Requirements:

On-Call Requirements:

Average salary estimate

$90000 / YEARLY (est.)

min

max

$80000K

$100000K

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What You Should Know About Coding and Compliance Auditor/Educator, Northside Hospital Inc.

The Coding and Compliance Auditor/Educator position at Northside Hospital in Atlanta promises an engaging and rewarding career for those passionate about healthcare compliance. As part of an award-winning facility, you'll play a crucial role by ensuring the integrity of medical record documentation including CPT, ICD-10, and HCPCS codes. Your expertise in auditing and compliance will be put to use as you review claims, provide educational support to physicians and staff, and maintain high-quality coding standards. You'll interpret complex medical records, apply established guidelines, and deliver professional reports of your findings to enhance the overall quality of care. Open communication with the Auditing Supervisor will be essential, as you maintain an impressive accuracy rate of over 90%. Your advanced knowledge of medical terms, coding regulations, and Medicare/Medicaid policies will set you apart as you help improve clinical and revenue cycle activities. Plus, public speaking and presentation skills will empower you to educate your colleagues effectively. If you're ready to bring your analytical skills and attention to detail into a trusted healthcare environment, Northside Hospital encourages you to explore this exciting opportunity to contribute to improving healthcare standards and patient care in Atlanta.

Frequently Asked Questions (FAQs) for Coding and Compliance Auditor/Educator Role at Northside Hospital Inc.

What are the primary responsibilities of a Coding and Compliance Auditor/Educator at Northside Hospital?

As a Coding and Compliance Auditor/Educator at Northside Hospital, your primary responsibilities will include reviewing medical record documentation to ensure correct coding, interpreting healthcare guidelines for ICD-10, CPT, and HCPCS, and delivering educational support to both physicians and practice staff based on audit findings. You'll also need to maintain high accuracy in your work and complete tasks in alignment with departmental production standards.