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Compliance Auditing Specialist

4 months ago

Valhalla, United States Wmc Health Full time
Job Details: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 fieldLicenses / Certifications:Other:Special Requirements:About Us:NorthEast Provider Solutions Inc.

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