Compliance Analyst - Coder

Compliance Analyst - Coder

To oversee and perform internal audits in an assigned area (Hospital, Provider, or Research) to ensure regulatory compliance in areas such as documentation, coding, billing, and research. To educate providers and departmental staff on regulatory compliance guidelines, research regulations, and / or coding and billing requirements.

Education and Experience Required : Degree (Bachelor's or Associate's) and three (3) years of ICD-9 / ICD-10 coding, CPT coding, research, and / or billing experience Certifications, Licenses, or Registration Required : N / A Preferred Qualifications : Certification from American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), Health Care Compliance Association (HCCA), Association of Clinical Research Professionals (ACRP), and / or Society of Clinical Research Professionals (SoCRA)

Knowledge, Skills, and Abilities : Knowledge of program / subject area (Hospital, Provider, or Research) statutory or regulatory provisions and administrative procedures. Knowledge of CPT, ICD-9 & ICD-10 coding principles and guidelines, billing rules, medical terminology, insurance plans, and / or research regulations. Verbal and written communication skills. Interpersonal skills to effectively interact with patients, clients, and other compliance staff members. Skill in applying regulatory guidelines to identify and solve problems. Skill in conducting compliance training. Ability to gather and analyze medical records and billing data and generate reports. Ability to present educational information.

Responsibilities :

• Performs audits on an assigned area (Hospital, Provider, or Research) and reports results to appropriate personnel.
• Participates in the development of educational and training programs that focus on elements of the compliance program; explains compliance program guidelines, policies, and procedures to departmental staff and physicians.
• Analyzes operating procedures, identifies potential violations, and provides technical assistance / recommendations to management.
• Collaborates with managers to identify aberrant trends in the coding, billing, documentation, research, and other compliance areas, as applicable.
• Confers with external auditors to ensure compliance of an assigned area.
• The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Physical and Environmental Demands : Requires occasional working hours significantly beyond regularly scheduled hours, occasional traveling to offsite locations, occasional activities subject to significant volume changes of a seasonal / clinical nature, constant work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 50 pounds, occasional crouching / stooping, occasional driving, constant sitting, occasional standing, occasional twisting, and occasional walking. (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Time Type : Full time FLSA Designation / Job Exempt : Yes Pay Class : Salary FTE % : 100 Work Shift : Day Benefits Eligibility : Grant Funded : No