Contributes to coding quality audits by conducting special projects, audits, reviews, and monitoring of assigned lines of business or scope to assess the accuracy and quality of coding and documentation. Supports audit analysis and report writing by comparing coding and documentation across the enterprise to identify risks, trends, and remedies, and by preparing written audit reports. Helps enhance coding integrity by supporting teams in developing, implementing, and monitoring new workflows that align with regulatory, reimbursement, and business requirements. Ensures compliance with national, state, and organizational coding, billing, and documentation guidelines.
Essential responsibilities
- Provide information, resources, advice, and expertise to coworkers and stakeholders.
- Build relationships with cross-functional and external partners.
- Work autonomously on business-specific projects and contribute creative solutions.
- Collaborate across teams to support business decisions and resolve complex problems.
- Develop work plans to meet priorities and deadlines.
- Identify improvement opportunities and guide stakeholders toward solutions.
- Conduct audit analysis and trend review to identify patterns, compliance drivers, liabilities, and performance indicators.
- Prepare standardized audit reports and provide education as needed.
- Perform coding quality audits, special projects, reviews, and monitoring independently.
- Follow national, state, and organizational coding, billing, and documentation guidance.
- Support compliance efforts through committees and national compliance programs.
- Help identify coding and documentation trends and communicate regulation and guideline changes to impacted staff.
Minimum qualifications
- At least 2 years of experience in ICD-10-CM, CPT, and HCPCS coding, including chart auditing, diagnosis/procedure coding, or coding reviews.
- Either an associate degree in Health Information Management, Health Care Administration, or related field plus at least 5 years of experience in health care compliance, health care operations, audit, insurance/health plan governance, coding, medical record review, or a directly related field; or at least 6 years of experience in those areas.
- One of the following credentials required at hire: RHIT, CCS-P, RHIA, CPC, or CCS.
Preferred qualifications
- Risk Adjustment Certification.
- 5 years of auditing experience.
Knowledge and skills
- Audits and internal audit processes
- Compliance management and health care compliance
- Data quality and quality improvement
- Medical coding and medical terminology
- Critical thinking and problem solving
- Written and topic-specific communication
- Cross-group collaboration and influencing others
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$103,400 - $133,760
Remote work allowed
No
Posted
1 month ago