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Responsibilities

Job Summary / Purpose

The Sr Coding Compliance Auditor is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture. Provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules. Develops, maintains and presents coding and compliance educational materials to staff and clinicians. Collaborates with the coding team to support the needs of the organization. The position will support risk adjustment improvement efforts across the medical group. The Hierarchical Condition Category (HCC) Quality program was developed by CMS to promote quality care for Medical Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level. The Sr Coding Compliance Auditor’s primary focus will be to facilitate and ensure the comprehensive capture of chronic conditions for the purpose of accurately reporting HCC’s. Prospective and concurrent reviews will account for 70% of the workload with the other portion of time focused on provider communication, and claims denial resolutions. Communicates denial trends to leadership and works with practice managers to resolve these trends. The position will create and develop sustainable workflows as this will be a new area of focus. Additionally the role will assist with educating providers on quality opportunities as well. Clinical background preferred but not required.

Essential Key Job Responsibilities

+ Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims.

+ Works to resolve claims denials and reports denial trends to leadership

+ Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients’ chart note.

+ Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures.

+ Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process.

+ Assists in the development and reporting of HCC and Pay for Performance metrics.

+ Adheres to deadlines and ensures reports are completed and distributed to all concerned parties.

+ Provides structured and ad hoc training/education to staff and providers.

+ Performance necessary analysis of data for the purpose of identifying trends and making suggestions for change to process. Develop action plans based on analysis.

+ Works collaboratively with Revenue Cycle Staff, Coding team, Clinical Informatics, and other MMS staff associated with HCC Initiative.

+ Identifies claims correction opportunities and submits to appropriate personnel for processing.

+ Acts as documentation and coding liaison to clinicians to include review, education and necessary follow-up to help ensure that clinical documentation and coding services meet government and organizational policies and procedures.

+ Performs periodic face to face visits, to assigned offices, to provide documentation education and assist with workflow issues, while building a rapport with practice managers, office staff, and providers.

+ Prepares necessary reports and communicates results of audits to management, clinicians, and committees as appropriate.

+ Reports areas of risk directly to the Coding Integrity Manager/Supervisor.

+ Maintains a high level of competency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by attending appropriate workshops and seminars.

+ Working knowledge of concepts, practices, policies, procedures, standards, systems and tools applicable to medical records coding; including documentation requirements and medical terminology.

+ Possess a strong work ethic with demonstrated ability to work independently or collaboratively as part of a team with multiple priorities and deadline constraints.

+ Maintain confidentiality of patient information.

+ Participate in departmental projects in order to enhance efficiency, systems, education, patient care or personal growth.

+ Participates in special projects and completes other duties as assigned.

Qualifications

Required Education

Associate Degree preferred.

Required Licensure and Certifications

Coding Certification through American Health Information Management Association (AHIMA) as Certified Coding Specialist (CCS) or Certified Coding Specialist Physician Based (CCS-P)

or the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) required.

Professional Medical Auditor Certification (CPMA) (CMAS)-preferred but not required.

CRC Certification preferred or must be obtained within the first year.

Prefer RN, LPN, or CMA state of TN/GA but not required.

Overview

CHI Memorial Mountain Management

CHI Memorial Medical Group (Mountain Management Services), now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health, is a Management Service Organization (MSO) that provides comprehensive office management services for all Memorial Health Partners and many physicians in private practice. We are proud to be a part of the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia.

We care about our employees’ well-being and offer benefits that complement work/life balance.

We offer the following benefits to support you and your family:

Free Membership to our Care@Work program supporting any child care, pet care, or adult dependent needs

Employee Assistance Program (EAP) for you and your family

Health/Dental/Vision Insurance

Flexible spending accounts

Voluntary Protection: Group Accident, Critical Illness, and Identity Theft

Adoption Assistance

Paid Time Off (PTO)

Tuition Assistance for career growth and development

Matching Retirement Programs

Wellness Program

If you are passionate about the patient experience and ready to join our nationally recognized hospital, connect with us today!

Pay Range

$23.98 - $34.78 /hour

We are an equal opportunity/affirmative action employer.