CODING AUDITOR- ADMINISTRATION

Summary

Ensures compliance and billing accuracy across the State of Franklin Healthcare Associates market.

Essential Duties and Responsibilities

• Conducts provider chart audits analyzing coding and medical record documentation. Prepares oral and written reports to Management and providers regarding findings and recommendations.
• Meets with providers to review audit findings and provides additional education.
• Performs follow-up reviews to ensure improvement if warranted
• Conducts targeted coding audits as warranted.
• Offers support to CBO for coding guidance.
• Pursues professional development activities to ensure knowledge of current coding and documentation requirements.
• Maintains strictest confidentiality.

Other

• Compiles information and prepares reports.
• Maintains records.
• Participates in educational activities.

• Follows organizational policies and procedures, including State of Franklin Healthcare Associates Compliance Manual, Code of Ethics and Business Standards, HR Policies and Procedures Manual, Team Member Handbook, OSHA Manual and any other policies or procedures for the job function, department, location or clinic.
• Performs other duties as assigned.

Direct Reports

N/A

Qualifications

Knowledge of organization policies and procedures. Knowledge of computer systems and applications. Knowledge of CMS documentation standards. Knowledge of ICD-10 and CPT coding. Knowledge of medical terminology, billing reimbursement, and Correct Coding Initiative. Skill in planning and organizing. Skill in exercising initiative, judgment, problem solving, and decision making. Skill in developing and maintaining effective relationships with medical and administrative staff.

Education

High school diploma or GED.

Experience

At least two years in E/M auditing or E/M coding of provider charts preferred. Experience with Allscripts Professional, Centricity, and Intelicode preferred.

Certificates, Licenses, Registrations

Certified Professional Coder (CPC) or equivalent and Certified Professional Medical Auditor (CPMA) or equivalent is required.

Competencies

Teamwork: Maintains a positive working relationship with team members; acknowledges strengths and contributions of others; supports team goals and objectives.

Compassion: Professional and respectful to patients, co-workers and others; remains calm when faced with challenging or difficult situations; manages and resolves conflict in a constructive manner.

Extra Effort: Makes the best use of time during work hours; looks for opportunities to help others when assigned work is complete; goes above and beyond to ensure priorities are achieved.

Excellence:

• Quality/Continuous Improvement: Ensures accuracy and completeness of work performed; contributes ideas and methods for improvement; receptive to suggestions and new ideas; accepts constructive feedback and demonstrates improvement.

• Job Knowledge/Technical Skill: Proficient in required skills for duties assigned; able to navigate and resolve unexpected situations.

• Productivity/Dependability: Responsive to direction and instructions; demonstrates ability to set priorities; completes appropriate quantity of work within assigned time limits; follows through on assignments and notifies supervisor if unable to complete; exhibits good attendance record (excluding approved leave); gives appropriate notification of absence and schedules time off appropriately.

Working Conditions

Work is performed in a medical office environment involving contact with patients, physicians, staff, insurance carriers and other business partners. Occasional local travel between work sites and additional hours may be necessary.

Physical Requirements

State of Franklin Healthcare Associates reserves the right to alter, change or modify this job description at any time, with our without notice. The duties and responsibilities contained herein are considered representative, but not necessarily all-inclusive, of the duties and responsibilities, which may be required of a job incumbent. All other categorizations contained herein are meant to be representative of the general environment or working conditions in which the job is performed.