Senior Coding Compliance Auditor

2 weeks ago


Austin, Texas, United States ComplianceWise Full time
Position Overview

The Senior Coding Compliance Auditor will be responsible for conducting both prospective and retrospective evaluations of medical records. This includes thorough reviews to ensure that the documented services align with the reported CPT/HCPCS and ICD codes, while adhering to the relevant payer coding standards.

Key Responsibilities
  • Perform comprehensive chart reviews, including baseline assessments, routine monitoring, and focused evaluations.
  • Identify and analyze coding discrepancies, providing actionable recommendations for enhancements.
  • Effectively communicate audit findings to healthcare providers and ancillary staff, sharing insights for improvement.
  • Collaborate with the Office of the Chief Medical Officer and provider leadership to support coding accuracy.
  • Document and report findings to the Compliance Officer or designated personnel, as well as management and executive leadership.
  • Deliver ongoing education to providers and ancillary staff regarding CDT, CPT, HCPCS, and ICD-10 coding standards.
  • Ensure adherence to compliance policies in line with government (Medicare & Medicaid) and private payer regulations.
  • Conduct necessary research to maintain organizational compliance with all relevant coding and diagnostic guidelines.
  • Enhance professional knowledge by participating in educational workshops and reviewing industry publications.
  • Work collaboratively with various departments, including Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing, to ensure the accuracy of reported services and assist with chart reviews as needed.
  • Coordinate with the Purchasing department to procure and distribute annual coding materials across all clinical sites and departments.
  • Assist the Director of Compliance with incidents and investigations related to coding and documentation.
  • Provide support to other Compliance personnel in coding and compliance matters.
  • Advise the Compliance Officer or designated personnel on updates regarding government coding and billing guidelines.
  • Facilitate training sessions for billing coding staff on compliance-related topics.
  • Engage in special projects and undertake additional duties as assigned.


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