Compliance Auditing Specialist

NorthEast Provider Solutions Inc.
Valhalla, NY
Full-time

Job Details : Job Summary :

Job Summary :

Serves as an internal expert on Risk Adjustment and Hierarchical Conditions Categories (HCC) coding. Specific duties include performing concurrent and retrospective reviews of documentation and coding and working with providers and staff to ensure the accuracy and completeness of medical record documentation and coding.

Provides training, education and coaching to providers and staff regarding accurate and complete medical record documentation and coding in compliance with established documentation and coding standards.

Responsibilities :

  • Audits medical records to assure compliance with applicable coding and documentation standards. Manages query process that is consistent with industry standards, to identify and react to inaccurate documentation or coding.
  • Compiles data and determines priority areas for documentation and coding improvement activities. Monitors and reports key performance indicators relative to clinical documentation and HCC coding.
  • Documents and maintains records of all query, audit, and educational efforts. Tracks and reports on the effectiveness of the clinical documentation improvement program through record keeping and results analysis.
  • Maintains current competencies in clinical documentation improvement and ICD, CPT and HCC coding through continuing education.

Assists with compliance audits and other duties as needed.· Promotes appropriate clinical documentation through extensive interaction with physicians, nursing staff, and other patient caregivers to ensure that the documentation of the patient's severity of illness and clinical complexity is complete and accurate.

Serves as documentation and coding resource to practices and clients. Works with leadership to develop, document, implement and monitor procedures that support organizational goals and objectives related to the documentation & coding improvement.

Qualifications / Requirements :

Experience :

Approximately 3 years of experience in concurrent clinical documentation improvement relative to HCC coding in the ambulatory setting with one or more of the following credentials : Certified Risk Coder (CRC), Certified Professional Coder certification (CPC), Certified Professional Medical Auditor (CPMA) or Certified Clinical Documentation Specialist (CCDS) credential(s).

Education :

Bachelor's Degree in related field

Licenses / Certifications :

Other :

Special Requirements :

30+ days ago
Related jobs
NorthEast Provider Solutions Inc.
Valhalla, New York

Provides training, education and coaching to providers and staff regarding accurate and complete medical record documentation and coding in compliance with established documentation and coding standards. Audits medical records to assure compliance with applicable coding and documentation standards. ...

Promoted
Quality Talent Group
Katonah, New York

LPN will use nursing process judgment & ss to set priorities necessary to deliver quality direct resident care & make decisions promoting the safety/quality direct care to residents. Facility in Westchester County known for providing the highest quality care and resident experience. ...

Promoted
Lexitas Legal Talent Outsourcing
White Plains, New York

Our client, a leading insurance company located in White Plains, NY, seeks a Compliance Manager – Agency & Partnership, to manage the compliance program for insurance sales partnerships, including agents, brokers, managing general agents, third party administrators, and other sales, marketing, a...

Promoted
American Consumer Panels
Chestnut Ridge, New York
Remote

...

Promoted
Emerge Talent Cloud
Tarrytown, New York

Quality Assurance (QA) Specialist. Prestige Consumer Healthcare is a company that focuses on product innovation and quality in the over-the-counter healthcare and women’s health categories to better improve the lives of our customers and their world. Quality Department supporting QA managers i...

Promoted
Maid Right of New Rochelle
New Rochelle, New York

Assist Quality Assurance Manager with training needs. Physically and mentally capable of performing Quality Assurance Manager duties. Conduct regular quality assurance visits with unit franchisee. Drives revenue through high customer retention, focusing on Unit Franchisee training and ensuring high ...

Promoted
Westhab Inc.
Mount Vernon, New York

The Quality Assurance Manager is responsible for developing, managing, and oversee our teams DSS quality control and management processes. Under the guidance of the Program Manager, you will also report incidents related to quality assurance and regulatory non-compliance. At minimum 2 years’ e...

JCC Association
West Nyack, New York

This administrative position supports the daily operations of both development and sports and recreation departments through administrative, logistical, and strategic work. JCC Rockland is seeking a full time in-person Assistant to join two growing departments. Provide administrative support for all...

Vision Homecare Services
New Rochelle, New York

The Credentialing Specialist will play a vital role in the recruitment, credentialing, and onboarding process of home health aides, nurses, and other healthcare professionals for our New York State licensed home health care agency. The ideal candidate will ensure that all personnel are properly cred...

Madison-Davis
NY/LA

Large broker dealer located in Midtown Manhattan or Los Angeles looking to add a “VP – Capital Markets Compliance Officer” to their team. Assist with the design and execution of regulatory compliance testing for Capital Markets business; test compliance with policies and standards and identify key r...