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Job Description
Overview:
A non-exempt position responsible for conducting professional coding and documentation audits with follow-up face-to-face, telephonic and/or web-based education with providers.
Responsibilities:
Conducts medical record documentation reviews of CPT-4 and ICD-10-CM coding according to set schedule for all UofL Health billing providers and UofL Health Coders.
2. Completes individual and departmental coding summary reports, provides explanation of findings and offers education. Coordinate and provide ongoing training and education to providers and ancillary staff on documentation improvement initiatives related to the selection of CPT (especially E/M levels), ICD-10-CM and HCPCS in accordance with federal, fiscal intermediary and organizational specific guidelines. Training and education will be initiated after review of audit results. Compliance auditor should maintain a competent understanding of all coding regulations and guidelines, coding updates and applicable clinical knowledge (i.e., anatomy and physiology, disease processes, procedures) necessary to be a proficient provider compliance education resource.
3. Shadow providers when appropriate and work on individual coding and documentation goals outlined by Provider, SVP of Compliance and/or as directed by Compliance Committee after audit results reviewed if necessary. Ability to accurately interpret encounter forms, medical records, physician documentation, lab and operation reports and other
documents necessary for accurate billing and coding.
4. Utilizes Audit software to audit medical records, generate reports, analyze for trends and initiate provider or staff education.
5. Reviews and explains audit results with SVP of Compliance, Risk & Audit Services.
6. Prepares, initiates and monitors provider and departmental post-audit follow-up action plan based on review findings.
7. Keeps informed on coding and documentation guidelines, federal and state compliance regulations. Ability and ease with presenting education information to group and individual providers. Critical thinking skills to look at “total” picture and ability to research topics to better understand and explain complex medical coding/billing issues as required.
Qualifications:
Education:
Minimum of 3 years of experience with a licensure and/or certification in at least one of the following: RHIA,
RHIT, CCS, CCS-P, and CPC.
- Additional credential of Certified Professional Medical Auditor (CPMA) within 1 year of position employment.
Experience:
A minimum of 3 years CPT and ICD-10 coding and/or documentation and billing auditing for providers.
Licensure:
Must maintain a valid driver’s license and have reliable transportation for the purposes of meeting with providers
at our various clinic/hospital locations.
Certification:
- RHIA, RHIT, CCS, CCS-P, and CPC.
- Additional credential of Certified Professional Medical Auditor (CPMA) within 1 year of position employment .
