What are the responsibilities and job description for the Coding Auditor (Hybrid Remote) position at Cardiovascular Institute of the South?
Job Duties : -Develop and maintain physician audit plan to include a yearly review of :
a. Clinic and hospital EM services
b. Medical necessity issues with Denials and encounters no-billed
- Perform coding and billing audits and provide written audit reports to administration and the providers.
- Perform data analysis to ensure coding compliance of providers, including level of service analysis against Medicare and other pertinent benchmarks, i.e. MedAxiom and White Plume reports.
- Develop and present educational materials, based on audit findings, to providers, management, coding and billing staff on correct coding guidelines and government policies per state regulations.
- Develop policy guidelines and procedures in accordance with governmental regulations and the medical industry standards / practices. Research, develop and maintain documentation on coding guidelines for physician practices.
- Maintain thorough knowledge of CMS / Medicare / Medicaid & private payer, NCDs, LA MC LCDs, documentation and coding rules for cardiology.
- Prepare communications for practice administrators and others on identified issues and pertinent changes.
- Act as liaison between business services and clinics on coding issues.
Job Requirements :
Standards of Performance :
1. Keeps work area neat and organized. Reports safety issues to team leader immediately.
2. Works efficiently and manages time wisely. Assist other employees when all duties are complete.
3. Communicates any problems, difficulties or concerns regarding job duties to the team leader.
4. Performs all duties without significant error occurring with any regularity.
5. Meets all deadlines and timeframes for completion of assignments.
6. Represents CIS in a professional manner at all times. Demonstrates acceptable ability to interact with physicians, staff ("internal customers") and "external customers" (patients, family members, insurance companies, home health etc.) on a professional level at all times. Exhibits good communication skills with physicians, patients, team leaders, and co-workers at all times.
7. Exhibits whenever possible a harmonious relationship with other employees in order to accomplish the duties and responsibilities of the position. While perfect harmonious relationships with all employees are sometimes not achievable, not more than an occasional complaint should be received by the team leader about the incumbent of this position.
8. The employee shall work and relate cooperatively with all other employees (internal customers) to assure optimum care for the patients and to achieve standards of care set forth by the medical staff.
9. Adheres to the Compliance Plan as it pertains to the above specific job duties. Uses best efforts to maintain compliance by following the Corporate Compliance Plan, attending compliance education, following medical documentation guidelines, and communicating concerns regarding compliance issues.
10. Performs accurate and complete documentation in the patient's medical record, when applicable.
11. Work with the electronic medical record (EMR) staff to maintain quality and work towards future EMR development.
12. Maintains patient confidentiality according to the HIPAA standards of privacy and security.
