Job Description
Performs complex coding audits, drafts findings and advises with organization leadership to provide education on regulations and mitigate compliance risk.
Job Responsibility
- Reviews data, such as claims detail, coding and medical record documentation to determine compliance with appropriate coding and documentation requirements.
- Drafts reports detailing coding audit findings.
- Assists with billing / documentation and regulatory risk assessments.
- Acts as the internal expert on coding issues to ensure compliance with state and federal regulations.
- Research, interpret and communicate federal and state laws and guidelines pertaining to Medicare and NYS Medicaid.
- Completes thorough reviews of governmental coding audits determining potential non-compliance and future compliance risk.
- Provides general compliance education and support to audit and facility staff involved in coding and billing; focused training based on results of compliance audits and self-assessments.
- Collaborates with Internal Audit, Faculty Practice and Research Compliance to minimize overlap in compliance activities.
- Operates under limited guidance and work assignments involve moderately complex to complex issues where the analysis of situations or data requires in-depth evaluation of variable factors.
- Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act.
Duties not mentioned here, but considered related are not essential functions.
Job Qualification
- Bachelor's Degree required, or equivalent combination of education and related experience.
- Current Professional Coder Certification, or Current Coding Professional Certification required, plus specialized certifications as needed.
- 3-5 years of relevant experience, required.
- Additional Salary Detail
The salary range and / or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.
When determining a team member's base salary and / or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
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