Coding & Compliance Auditor

Job Description Summary

The Coding & Compliance Auditor evaluates medical record documentation and coding accuracy, identifies opportunities for improvement, and designs and delivers coding education and training programs for clinical staff, coders and other key stakeholders. The Coding & Compliance Auditor monitors external regulatory and internal process changes and provides support to colleagues in adhering to Federal, State and local requirements.

Job Description

Essential Functions

1 - Identifies staff and management training and education needs and makes recommendations for appropriate interventions.
a - Assess organization-wide compliance training needs through auditing or other review techniques to assess current state and potential compliance gaps.
b - Analyzes data to identify deficiencies/weaknesses in the performance of job-related competencies.
c - Recommends appropriate training program to address identified training needs.

2 - Designs and develops training programs:
a - Develops and reviews all training materials used for compliance training/education programs to ensure accuracy and relevance to the program objectives.
b - Designs training programs with course objectives written in performance-based language and linked to job-related competencies.
c - Designs program content, training materials and instructional methods to meet the learning style of the targeted participants
d - Develops course proposals.
e - Evaluates vendor-training materials for its application or recommendation for use in educational programs.

3 - Conducts and evaluates training programs:
a - Organizes and presents course content based on adult education learning principles.
b - Uses audio-visual aids, including overhead projectors, slide projectors, video, and computers to enhance presentations.
c - Revises/modifies materials, delivery methods and instructional tools as necessary based on participant and/or supervisor feedback to ensure training objectives are met.
d - Verifies that participants have mastered the skills and/or knowledge-based course objectives by building performance assessments and/or feedback mechanisms into the training courses.
e - Assists in the development of follow-up mechanisms to ensure that knowledge and/or skills learned in the training are being applied on the job and have an impact on staff performance in meeting organizational goals.
f - Assists in the scheduling or programs to maximize employee attendance.
g - Produces reports of program effectiveness and documentation of program attendance.

4 - Self Development:
a - Participates in professional societies or organizations relevant to ICD-9-CM, ICD-10-CM, PCS and CPT.
b - Attends continuing education activities to enhance professional development and to maintain proficiency in adult learning techniques and health care trends.

5 - Administrative Duties :
a - Assists with administering programs as assigned.
b - Attends and participates in organization-wide committees as assigned.
c - Performs additional related duties are required.

6 - Designs, develops and delivers education and training programs that meet the staff’s needs for professional and personal development.

7 - Plans and develops curricula in accordance with the organization’s strategic goals, mission and business strategies to improve employee performance leading to quality data and accuracy.

8 - Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process.

JOB REQUIREMENTS

Minimum Education - Preferred

Associates or Bachelor’s degree in Health Information Management.

Minimum Work Experience

Minimum 5 years acute care coding with demonstrated expertise in ICD-9-CM, ICD-10-CM, PCS and CPT coding.
Experience, preferred, in adult and continuing education, organizational development and training.

Required Certifications

CCA - Certified Coding Associate (AHIMA-American Health Information Management Assoc) or

CCS - Certified Coding Specialist (AHIMA-American Health Information Management Assoc) or

CCS-P - Certified Coding Specialist-Physican Based (AHIMA-American Health Information Management Assoc) or

CPC - Certified Professional Coder (AAPC-American Academy of Professional Coders) or

CPMA -Certified Professional Medical Auditor (AAPC-Academy of Professional Coders) or

RHIA - Registered Health Information Administrator (AHIMA-American Health Information Management Assoc

Required additional Knowledge and Abilities

Interact with constituents who have competing priorities and effectively communicate the importance of compliance in a respectful yet authoritative manner.