Under limited supervision, conducts annual and periodic audits of coding and documentation of procedures and services performed by MFA physicians. Follows policies of CMS, AMA and commercial carriers to assure consistent quality and adherence to coding principles and documentation requirements. Provides ongoing training and acts as resource person to physicians, non-physician providers, support staff, administrators and other personnel on third party payer documentation and coding requirements.
Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
- Audits documentation and coding to include, but not be limited to, inpatient and outpatient progress notes, operative reports, encounter forms, and other documentation of procedures and ancillary services performed by physicians and non-physician providers.
- Prepares written reports of audit findings and recommends corrective actions plans as needed and appropriate.
- Meets with physicians and non-physician providers to provide findings and education.
- Participates in educational and training programs to ensure correct documentation and coding and adherence to the MFA Corporate Compliance Program.
- Maintains working knowledge of CMS (Medicare and Medicaid) regulations and Novitas Local Medical Review Decisions (LCD) and National Review Decisions (NCD). Familiarity with AMA Coding Guidelines, and AHA guidelines. Reviews insurance carrier bulletins and healthcare industry periodicals.
- Correctly prioritizes own activities in accordance with outstanding audit projects and other work demands. Remains flexible and ready to assume additional responsibilities as needed.
- Demonstrates diligence, independence and initiative, acts as resource to other compliance department auditors.
- Performs other duties as assigned.
The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
High school or equivalent education required. Associates degree in HIM preferred. Certified Coder (CPC or CCS-P).
At least 3 years of professional coding and/or auditing.
Ability to build and use MS Excel spreadsheets, do math calculations, input data into the computer, and analyze patient medical and coding data as requested. Familiarity with medical terminology and E&M coding. Must be able to communicate providing verbal feedback in a professional manner. Must be able to follow and understand instructions, and react favorably in all work situations. Must be confident communicating and interacting with physicians and other healthcare personnel. Mentally adaptable and flexible in dealing with a variety of people.