Coding Compliance Audit & Education Specialist

Under indirect supervision, the Coding Compliance Audit/Education Specialist audits medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines.

• Conduct audits (i.e. baseline, routine periodic, and focused) comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes with consideration of applicable federal and state laws, regulations, and guidelines.

• Research, interpret and communicate federal and state laws and guidelines pertaining to CMS and Medicare.

• Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.

• Preparation of audit reports including summary of findings

• Conduct post-audit provider education with individual or large provider groups 

• Schedule trainings with provider’s offices, individual providers and groups of providers

• Provides feedback, initial and ongoing education and training, and technical support with regard to proper documentation guidelines, service selection, charge capture, supervision, timely submission, healthcare data accuracy, and coding principles.

• Communicates audit findings to providers to track education completion and escalation.

• Interacts professionally and effectively with physicians, leaders, staff, and internal teams.

• Provides coding assessment, consultation, education, and issue resolution to key stakeholders as requested.

• Able to have honest, difficult conversations with providers about compliance, documentation, and code assignment.

• Other duties as assigned