The Coding Compliance Analyst functions as a Subject Matter Expert in coding and billing compliance, performing audits, training staff, and ensuring compliance with department, state, and federal rules and requirements. Reviews and analyzes medical records and abstracted data to determine the accuracy of payment and code assignment and adequacy of clinical documentation in accordance with regulatory requirements. This position will also provide project planning, oversight, and implementation for the coding and billing department.
- Conduct regular and surprise/random audits and coordinate the monitoring of coding and documentation accuracy; review claim denials and rejections pertaining to coding and medical necessity issues.
- Create and provide educational training programs to appropriate staff, including coders, providers, and billing staff. Ensures that documentation, coding and billing requirements are fully understood.
- Create reports, documentation, and presentations for leadership on compliance issues and statistics as well as project progress.
- Keep abreast of pending regulatory changes; communicate necessary changes and pro-actively establish policies, procedures, processes and training to ensure coding and billing departments are in compliance with all Federal, State and carrier regulations at all times.
- Provide project planning, oversight, and implementation services for department, including assembling, coordinating and directing project teams; creating project timelines; ensuring project meets deadlines and stays within budget; and providing deliverables.
- Provide regular and prompt feedback to staff and supervisors on compliance issues, including participating in corrective action as necessary.
- 2 years of third party billing and reimbursement experience, specifically with Medicare and MediCal, required.
- 4 years of progressive coding experience required.
- Associates degree in Health Information Management or closely related field required.
- CPC certification required.
- Demonstrated experience in project management and implementations.
- RHIA, RHIT, or CCS certifications strongly preferred.
- Ability to accurately interpret/implement regulatory standards and legal requirements.
- Ability to perform audits and quality evaluations to validate compliance.
- Able to maintain good working relationships with employees, coworkers, and departments.
- Effective training and coaching skills; ability to drive results and achieve objectives through others.
- Excellent interpersonal and customer service skills.
- Excellent organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.
- Excellent written and verbal communication skills.
- Knowledge of current healthcare based technology, coding and Electronic Health Records.
- Strong skills in computer applications and software, including MS Office, Electronic Health Records, and others.
- Thorough knowledge of current and pending State and Federal health care rules and regulations pertaining to coding, Electronic Health Records, and billing.
- Thorough knowledge of ICD-9 and HCPCS/CPT as well as knowledge of ICD-10.
Family Health Centers of San Diego - 11 months ago