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Coding Compliance Auditor
2 months ago
What You’ll Do
The Coding Compliance Auditor will partner cross functionally with medical and coding staff to ensure accurate and timely coding for a first-of-its- kind pediatric risk bearing provider. This highly visible role will be instrumental in standing up a scalable auditing function following appropriate coding practices and regulatory guidelines in a remote-first, high-growth company environment to ensure all coding activities are handled in accordance with national coding guidelines and Imagine Pediatrics’ coding policies.
Review pediatric-based Medicaid records and documentation to ensure accurate and complete coding in accordance with official coding guidelines as set forth by CMS regulations, and other applicable federal and/or state guidelines (e.g., AHIMA, ACOG, CMS, Medicaid); and health plan-specific policies.
Build, implement, and maintain auditing processes which will include building standardized workflows to educate providers, partnering with data and technology teams to construct automated reporting dashboards, and working with coding managers to ensure iterative improvement on key metrics over time.
Collaborate and consult with internal clinical leadership on chart assessments to address coding discrepancies to maintain operational excellence and ensure continual delivery of high-quality care
Review audit findings with physicians and coding staff. Educate and recommended ways to improve as needed.
Perform follow-up audits to ensure remediation of findings and report the status of remediation efforts.
Prepare written reports of findings to the Chief Compliance Officer on charts reviewed per week, coding accuracy, and progress towards implementing and following guidelines
Provide guidance regarding need for external vendors and partnerships
What You Bring & How You Qualify
First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support they deserve.
3-5+ years of medical coding and auditing experience preferably in a high-growth environment
Knowledge of medical terminology, standard coding and reference publications, CPT, HCPC, ICD-9, ICD-10, DRG, etc.
Prior experience coding or auditing in a Medicaid environment
Experience providing training and education to staff and clinicians using excellent verbal and written communication skills
Thorough understanding of HEDIS measures and E&M coding
Bachelor’s degree in healthcare management or related field preferred
Familiarity with EMR software (e.g., Athenahealth)
CPC or CRC; and CPMA required
Excellent organizational, project and program management skills; experience leading change and implementing programs.
Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences.
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