Requirements

Education, Certification, Computer and Training Requirements:

¨ Associate degree minimum /Bachelor's Degree preferred

¨ Work related experience: 2 years minimum

¨ Previous supervising experience: preferred

¨ Proficient use of Microsoft Office Applications (Excel, Access, Word, PowerPoint)

¨ Medical Coding Certificate -- Required

¨ Coding Certification - CPC, CCS-P, CCA or RHIT- Required

¨ Auditing, Compliance and Billing or Practice Management Certifications -- CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, CRC etc. -- Preferred

**Position is located in Warren, NJ**

Description

General Job functions:

The Coding Compliance Analyst must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations, guidelines, benchmark standards, along with HCC and risk adjustment reporting measures. A high level of analytical and statistical skill sets is required in order to monitor the systems for data quality and integrity across the various functional applications.

The Coding Compliance Analyst position is responsible for running reports for coding, auditing, analysis review, trending, tracking purposes and coding compliance project management in conjunction with department initiatives. Additionally, responsible for maintaining Coding Compliance integrity of master files, claims, custom rules and worklist dashboard.

¨ Coding Compliance Project Management -- Educational or Physician Services Team

• Assist Manager with project management of special projects as assigned and coordinating tasks with co-workers as needed.
• Develops, maintains and implements tracking and reporting mechanisms related to compliance initiatives and activities
• Responsible to create department specialty and individual Provider reference tools
• Under the direction of the Senior/Lead and/or Manager, assists in management of the Auditor's or Department workflows, custom rules, coordination of medical records that are needed for audits, ensures timely complementation of projects, educational reviews, baseline reviews, etc.
• Coordination of records as needed for audit reviews, logging of scores and communication via secure link(s) when needed.
• Coordination of process for correcting claims accordingly based on final audit review, releasing only compliant claims for billing and management other claims that require additional review.
• Responsible for the review of the new provider/practice acquisitions existing coding tools for accuracy and re-creation of tools to ensure they meet organizational compliance standards
• Responsible for the electronic maintenance of Provider reference tools, general audit result outcomes.
• Responsible for reviewing and update references, along with communication of most current CPT/ICD 10/HCPCS/HCC codes

¨ Coding Compliance Risk and Baseline Assessment/Dashboard

• Assists in development of baseline audit reviews -- Coding Compliance dashboards
• Assists/performs audit reviews for risk assessment purposes or as needed to complete benchmarks
• Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates data-mining and analysis where appropriate and alerting the Manager and/or Director of any areas of concern

¨ Compliance Initiatives- Tracking/Report Analysis/Documentation Abstracting

• Run reports for Coding Compliance Department, Management Team and physicians as needed to communicate data of interest, work performed or ad hoc
• Exhibit strong research skills including knowledge of automated analysis tools and online research tools to conduct research on assigned issues
• Produces weekly and monthly reports to report status of Coding Compliance projects/initiatives and Provider compliance
• Prepare written reports of analysis and audit findings along with bell curves, graphs, etc. in order to present to Lead, Manager, Director, Physicians or other parties
• Ability to audit, abstract code medical record for proper assignment of diagnoses and procedure codes, E M level according to AMA, ICD-10-CM, HCC, CPT, CMS and OIG Guidelines
• Ability to abstract code diagnoses to highest level of specificity applying ICD9 guidelines, HCC and other risk adjustment reporting concepts
• Conducts audit reviews related to Coding Compliance initiatives and communicates/collaborates with Manager and other teams regarding audit outcomes and educational areas of opportunity

¨ Claims/Custom Rules/Master Files

• Assists with ensuring that compliance custom rules and master files are up to date in the practice management system, by maintaining and/or working Coding Compliance Worklist /custom rules
• Regularly monitors through reporting the status of compliance projects, audits and claims on hold to ensure timely follow-up and filing of claims

**Position is located in Warren, NJ**