Coding Compliance Resume Samples

The Guide To Resume Tailoring

Guide the recruiter to the conclusion that you are the best candidate for the coding compliance job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies

Tailor your resume & cover letter with wording that best fits for each job you apply

Resume Builder

Create a Resume in Minutes with Professional Resume Templates

CHOOSE THE BEST TEMPLATE - Choose from 15 Leading Templates. No need to think about design details.

USE PRE-WRITTEN BULLET POINTS - Select from thousands of pre-written bullet points.

SAVE YOUR DOCUMENTS IN PDF FILES - Instantly download in PDF format or share a custom link.

Create a Resume in Minutes

M Upton

Marty

Upton

846 Linwood Ville

Chicago

+1 (555) 153 5534

846 Linwood Ville

Chicago

Phone

p +1 (555) 153 5534

Experience Experience

Los Angeles, CA

Coding Compliance Auditor

Los Angeles, CA

Carter-Rodriguez

Los Angeles, CA

Coding Compliance Auditor

As requested by Director or Manager of Compliance, perform other audits or investigations of various health system operations relative to documentation, billing process, privacy, quality or other functions relating to proper compliance with governmental regulations, laws and policies. Maintain thorough and concise documentation throughout audits and/or investigation with dates, times, names and specific details. Report progress and findings to Manager
Proficient in organizing and compiling documentation and thoughts in order to provide supported opinions to the medical providers on audit findings
Assists on various special projects as determined by the Manager
Research, develop and present education programs to physicians, coders and management as requested
Report unusual and complex issues and situations to Manager for guidance. Recommend action plans to ensure that the function is meeting all expectations of senior management. Suggest process improvements
Review clinical documentation to determine adherence to established Government and third party billing guidelines, AMA, AAP, CMS, and American Anesthesiology Algorithms and coding policies
Performs other job-related duties within the job scope as requested by Management of Coding

Phoenix, AZ

Coding Compliance Manager

Phoenix, AZ

Roob, Cormier and Gottlieb

Phoenix, AZ

Coding Compliance Manager

Stay abreast of relevant LCDs, NCDs, billing and coding guidelines concerning the current areas of audit focus
Developing and overseeing an annual work plan
Serve as an expert resource to research and respond challenging coding questions
Reviews AHA and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates
Provides input regarding departmental budget specific to area of responsibility
Perform coding compliance and quality audits in support of Optum360's Compliance Program and client expectations
Focusing on acute and chronic conditions

present

Boston, MA

Manager, Coding Compliance

Boston, MA

Wiegand-Moore

present

Boston, MA

Manager, Coding Compliance

present

Assists in developing and executing Department educational plans related to coding matters, working in conjunction with the Director of Compliance education
Provides input and guidance in the development and review of detailed audit programs and reports to improve audit effectiveness and efficiency
Works with Department leadership to improve Department processes, and to enhance overall compliance posture of the overall organization
Manages audit engagements including managing his/her individual time, scheduling work and monitoring the progress of assigned audits
Develops, organizes and maintains spreadsheet data or worksheets related to coding and documentation compliance
Demonstrates outstanding work ethic, and works cooperatively with all team members and clients with a can-do spirit and team attitude
Manages specific area of expertise including research, keeping abreast of changes, and informing/educating other outpatient coding compliance team members

Education Education

Bachelor’s Degree in Finance

Temple University

Bachelor’s Degree in Finance

Skills Skills

Strong communication and presentation skills
Knowledge of medical terminology, ICD-9/10 and CPT-4 coding guidelines and methodologies
Intermediate knowledge of disease pathophysiology and drug utilization
Intermediate knowledge of MS-DRG classification and reimbursement structures
Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to work in a virtual setting under minimal supervision
Excellent time management, decision-making, organizational and communication skills
Strong background across a wide range of medical record review processes, including: Evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
Ability to work directly with physicians and clinical staff in an educational and resource role

Create a Resume in Minutes

11 Coding Compliance resume templates

Read our complete resume writing guides

Coding Compliance Auditor Resume Examples & Samples

5+ years of Coding experience in an Acute Care hospital
Associate's Degree in related field
CCS or CPC-H
Microsoft Office/Suite proficient (Word, Excel, etc.)
DRG validator experience
Working knowledge of 3M Encoder and Microsoft Access
RN Candidate

Coding Compliance Manager Resume Examples & Samples

Developing and overseeing an annual work plan
Providing accurate and complete identification and documentation of significant medical diagnoses
Focusing on acute and chronic conditions
Handling ad hoc requests as needed
3 years of billing and coding experience within a physician’s setting

Coding Compliance Auditor Educator Resume Examples & Samples

Coding certification required from a nationally recognized professional association; with experience in coding instruction with focus on E/M documentation
Minimum, Bachelor’s Degree or an equivalent combination of education or experience
Minimum, 5 years of active E/M chart auditing experience within the last 6 years
Minimum, four years related experience in professional fee billing and compliance, with extensive knowledge of Medicare and Medi-Cal guidelines, including teaching physician rules
Minimum, four years experience in education and training of physicians regarding coding and documentation guidelines
Excellent organizational skills, thorough follow through and the ability to work independently with minimal supervision and maintain confidentiality in all activities
Thorough knowledge of medical terminology, standard medical abbreviations and disease processes
Excellent computer skills, including MS Excel, Word, and PowerPoint
Comprehensive knowledge of claims submission and medical billing software; IDX proficiency preferred
Strong customer service skills required; with the ability to work effectively with management, staff and physicians
Ability to trouble shoot, identify problem areas, develop and implement solutions
Ability to abstract from medical records, reports, chart entries, and related patient documentation required

Coding Compliance Manager Resume Examples & Samples

Perform coding compliance and quality audits in support of Optum360's Compliance Program and client expectations
Analyze and interpret documentation from medical records
Clearly document audit findings and calculate error rates
Provide feedback and education as appropriate depending on findings
Serve as an expert resource to research and respond challenging coding questions
Assist client organization with internal or external Compliance reviews, including responding to Independent Review Organization findings, as applicable
Conduct auditor peer review audits as requested
American Health Information Management Association certification such as - RHIA / RHIT or CCS
7+ years of IP audit experience
Extensive experience with various electronic health record systems
Exceptional written and verbal communication skills to communicate in clear, concise terms to management at all levels including the ability to articulate complex regulatory information in layman's terms
Proficient in Word and Excel
Ability to organize and prioritize competing priorities

Coding Compliance Manager Resume Examples & Samples

Direct Reports 1-2 Sr. Auditor of Coding Compliance
Adheres to AHIMA’s Standards of Ethical Coding; AHIMA’s Code of Ethics; AHIMA’s Ethical Standards for CDI Professionals, ACDIS’ Code of Ethics, and the AAPC’s Code of Ethics, in addition to Conifer’s Ethics Standards
Strong leadership and communication skills, problem solving abilities; good knowledge of medical records systems
Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function
Five (5) years of previous relevant management experience related to coding compliance functions
Experience ICD-9-CM, ICD-10-CM/PCS, CPT, HCPCS, and CDI
AHIMA coding credential, CCS preferred
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

Coding Compliance Analyst Resume Examples & Samples

Implements, maintains, and creates ad hoc assignments in regards to Conifer systems, processes, and policies designed to ensure coding compliance
Independently investigates breakdown in processes and coordinates resolution for system reporting issues
Conducts independent analysis of data and trends; advises Coding Compliance Managers/Directors on issues concerning coding compliance risk areas and training needs
Works collaboratively with Coding Compliance Managers and Directors, other corporate departments and Clients on monitoring and reporting implementation as well as establishing analysts processes and procedures
Recommends new methods and processes that improve safeguarding Conifer and Clients in coding functions and strategic planning to mitigate risks associated with coding practices
Works with other areas of the organization (including Dell and Conifer Revenue Cycle Services), at the corporate, regional and facility/provider levels in the areas of data mining and business intelligence on issues related to coded data
Prepares and maintains templates for Conifer coding compliance audits
Keeps abreast on regulatory changes in coding requirements and analyze for potential safeguarding opportunities
Work directly with other Compliance team members to complete additional tasks/projects that are beneficial to the department or organization
Serves as back-up coding compliance auditor
Ability to work independently in a fast paced environment; strong organizational skills and experience is project management highly preferred
Must successfully pass pre-hire coding assessment
Knowledge of medical terminology, ICD-9/10 and CPT-4 coding guidelines and methodologies
Intermediate knowledge of disease pathophysiology and drug utilization
Intermediate knowledge of MS-DRG classification and reimbursement structures
Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures
Must be detail oriented and have the ability to work independently
Must display excellent interpersonal skills
Ability to demonstrate initiative and discipline in time management and assignment completion
Ability to work in a virtual setting under minimal supervision
Associates Degree in Business, Information Systems, Health Care Administration or related field or equivalent years of related Analyst experience is required
Demonstrates one to three years of experience in a healthcare organization applying ICD-9/10 and CPT coding conventions and guidelines, preferably in a hospital facility
AHIMA certification RHIT, CCS, or CCA required. Will consider a candidate who is CCA eligible within one year of hire

Billing, Coding, & Compliance Supervisor Resume Examples & Samples

Oversee all functions of the billing and medical record’s department
Oversee compliancy in all areas of the AR department
Ensures knowledge of multiple classification systems (ICD-9-CM, ICD-10-CM, CPT, and HCPCS) is applied and compliance is monitored
Professional certification (RHIT, CCS, CCS-P, CCA,CPC, COC, CPC-A, COC-A) or associate’s degree or higher in health information program
Minimum 2 years’ experience in HIM environment
Minimum 2 years supervisor experience
Knowledge of Medicare RBRVS
EMR/Practice Management Software
Microsoft Word, Excel, Power Point proficient
Laser Fiche
Knowledge of HCFA 1500 billing forms
Full understanding of denial management processes and prevention methods
Understanding of managed care terminology and practices like PPO discounts
Excellent verbal communication skills, organizational skills, creative thinking, and the ability to grasp basic computer skills with patient processing software
Excellent written skills to conduct annual performance appraisals, prepare letters, emails, memos, presentations, and counseling documentation
Ability to manage people, counsel problem employees, and employee’s work performance in a professional manner
Confidentiality is imperative
Ability to implement processes and change in a positive productive manner
Must be able to manage payroll and time punches
Multi-tasking abilities are essential to success
Must be able to interview, counsel, hire, and fire
Professional Image
Abides by all HIPAA guidelines and regulations
Work professionally, effectively, and efficiently in a team environment with patients, leadership, clinical staff, and HO employees
Servant Leadership
Willingness to be trainable and teachable in all situations
Ability to hold department accountable to maintain and surpass goals
Proactively plan for department needs and initiate goals
Supports company and supervisor leadership at all times
Must be able to conduct productive and effective team meetings on a regular basis

Coding Compliance Consultant Resume Examples & Samples

Effectively prepares a well-developed audit approach and documents high quality working papers for complex risk adjustment, encounter data, coding, billing and other compliance audits
Responsible for planning, conducting and documenting for complex risk adjustment, encounter data, coding, billing compliance audits/initiatives and other duties as assigned
Understands & documents business systems/processes using narrative &/or flowcharting techniques
Analyzes audit findings, determines “causal factors”, formulate opinions, cites specific regulations/standards, and develops recommendations
Prepares working papers documenting & supporting compliance audit procedures and results. Ensures that working papers contain adequate evidence to support audit findings
Expected to continue developing broad, in-depth audit knowledge, experience & skills, as well as the ability to function independently & as a team member
Works closely with team members, operational leaders and physicians on key risk adjustment, encounter data, coding and billing issues
Researches and stays abreast of risk adjustment, encounter data, coding and billing regulations and statutes. Communicates required changes and develops tools to validate pertinent data
Demonstrates good interpersonal skills and communicates effectively both verbally and in writing
Prepares accurate & timely formal written reports & makes oral presentations to management on findings & recommendations
Provides periodic informal work guidance/direction to, and training of team members with less experience
Work under the guidance of an Auditor-in- Charge (AIC)
3-5 years of Professional and Hospital (inpatient and outpatient) coding and billing experiences
Proficiency in The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM,) The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II coding
Instruction in ICD-10 may be considered in lieu of ICD-10 coding experience
Very knowledgeable with Hierarchical Condition Categories (HCC) for both Centers for Medicare & Medicaid Services (CMS) and The U.S. Department of Health and Human Services (HHS)
Comprehensive knowledge of medical diagnostic and procedural terminology
Demonstrated experience in conducting Medical Record audits and ability to interpret and apply Federal and State regulations, coding and billing requirements
Demonstrated experience in presenting audit findings to Operational leaders
Certified Coding Specialist (CCS) and Certified Professional Coder (CPC) certifications – highly preferred
Able to work well under pressure and meet strict deadlines
Comfortable learning and using web-based audit tools
Advanced knowledge of Microsoft Excel, Word, and PowerPoint
Ability to travel 10%
Registered Health Information Administrator (RHIA) or (Registered Health Information Technician) RHIT

Coding Compliance Director Resume Examples & Samples

Personnel Management: Manages the efforts of direct reporting, as well as matrix reporting, positions. Responsible for selecting, developing, and deploying personnel in the most effective manner to meet objectives. Responsible for performance management, compensation decisions, and providing on-going, regular developmental feedback. Influences performance management, compensation decisions, and ongoing feedback for individual contributors reporting to direct report managers, possibly through more than one layer of subordinate management
Communications, Stakeholder Management, and Negotiation of Agreement: Facilitates communications, manages relationships with stakeholders, and garners support and agreement from involved parties for compliance initiatives and programs for functional areas across the enterprise
Issue Management, Response, and Mitigation: Responsible for issue management, response, and mitigation for functional areas across the enterprise. Proactively identifies risks and issues related to projects and production operations. Anticipates and addresses issues through regular communication with reporting positions and other internal and external parties at all levels, mitigating risk or, in the most severe cases, escalating issues for resolution by more senior levels as necessary
Change Management: Responsible for leading change management efforts for functional areas across the enterprise. Identifies and acts upon opportunities to leverage direct reporting team in change management activities; ensures direct reporting team is engaged in change management as appropriate
Project Management: Responsible for management of project plans for objectives or projects for functional areas across the enterprise as well as ensuring project timelines and objectives are met for projects managed by reporting positions
Strategic development: Participates in the identification and development of objectives, goals, and strategy relative to functional areas across the enterprise
Participates as a member of the National Compliance Office (NCO) Team Leader group in the development, implementation, monitoring and completion of NCO’s strategic plan
Ensures successful collaboration with the Permanente Federation and Permanente Medical Groups to support activities that ensure accurate and complete coding
Directs and demonstrates coordination with the Regional Compliance Officers to ensure that the coding compliance function is effective in the regions in partnership with National Compliance efforts
Directs the identification and mitigation of revenue cycle coding compliance risk associated with billing, risk adjustment, encounter reporting, and reimbursement for all lines of business
Directs an effective coding compliance monitoring program for risk adjustment and encounter reporting activities across all lines of business. Responsible for developing and delivering services to a national chart review function, which will be tasked with performing independent monitoring for coding accuracy. Will lead the investigation of coding discrepancies identified in reviews to determine the causes of discrepancies
Directs the process for monitoring new regulations and sub-regulatory requirements that impact medical services coding. On an on-going basis, oversees the researching and interpretation of regulations and laws to establish coding compliance standards, and may direct the development and/or delivery of coding training and coding communications/change management relative to new standards. Collaborates with relevant stakeholders across all government lines of business to ensure appropriate implementation and compliance
Provides external government audit support, coordination, and trend analysis in the areas of coding compliance in partnership with Government Audit Services. This includes Risk Adjustment Data Validation, the Commercial encounter data validation, RAC audits, and any other audits of reimbursement
The Director will partner with compliance peers to ensure remediation of potential data submission errors and claims made in error and develop education regarding trends identified. May direct the investigation of violations of compliance policy, laws, regulations, etc. or on-going monitoring and reporting to ensure remediation
The Director will also partner with compliance peers in the creation of an annual coding compliance plan and the development of coding and compliance policies, procedures and processes. Accountable for brokering agreements and gaining support for coding compliance initiatives from decision makers at all levels. May be responsible for project management relative to new coding related compliance, ethics and integrity initiatives, products, or annual processes
Ensures that the Coding Compliance team contributes effectively to the Reimbursement Compliance Groups designed to deliver reimbursement, coding, and clinical compliance requirements collectively to care delivery communities of practice
Create and implement an effective compliance program that supports the enterprise-wide revenue cycle and government reimbursement operations, as described above and, including
Providing compliance leadership support to the Revenue Cycle executive leadership team, as well as the Finance team, the Finance Compliance Committee, and any Health Plan reimbursement leadership forums
Serve as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations
Conduct enterprise risk assessments of potential and detected coding compliance deficiencies
Ensuring appropriate training and awareness of coding / revenue cycle compliance risk
Partnering with revenue cycle stakeholders to create and implement coding revenue cycle compliance policies and procedures
Minimum five (5) years of management experience
Minimum twelve (12) years of compliance-related experience
Bachelor’s degree in related field (Health Care, Business, etc.) Master degree preferred. Significant revenue cycle compliance experience preferred
10+ years of escalating managerial work-experience in a highly diversified organization (KP experience preferred)
5+ years of escalating responsibility and work-experience in compliance field (internal audit, compliance, etc.); to include progressive management roles in large, complex organization with successive levels of accountability and results
Significant compliance orientation, coupled with business process expertise and acumen. Demonstrated knowledge of current thinking and practice around the business of compliance
Significant knowledge of all pertinent regulatory requirements and compliance program elements
Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas. Demonstrated ability to influence and motivate interdisciplinary teams and individuals who do not report directly to the CCO
Demonstrated strength in organizational development, project management, and strategic planning
Superior communications skills (both oral and written)
Demonstrated high ethics and integrity
This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente’s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanente’s policies and procedures

Coding Compliance Auditor Resume Examples & Samples

Articulate audit findings appropriate for audience. Prepares written audit reports as needed summarizing audit findings and any corrective action necessary to mitigate risk
Participate in client meetings and / or calls
Stay abreast of relevant LCDs, NCDs, billing and coding guidelines concerning the current areas of audit focus
Research, develop and present education programs to physicians, coders and management as requested
Highly knowledgeable and experienced in the areas of ICD - 10 - CM and PCS, CPT and HCPCS coding systems. Proficient across a wide range of services offered in the inpatient and outpatient setting
Experience analyzing coding and billing data for patterns and trends
Demonstrated ability to analyze potential compliance and quality concerns
Experience coding and / or auditing facility E / M codes

Senior Director, Coding Compliance Resume Examples & Samples

Develops and maintains knowledge and understanding of: Conifer Health and its business operations and strategy; industry laws, regulations, and guidelines; external legal, regulatory, and business developments
Develops and implements internal controls through policies and procedures, training and education, auditing and monitoring, compliance risk management, and regulatory change management to help reduce the organization’s overall compliance risk
Supervises, develops, and directs performance for all direct reports
Prepare annual departmental budget specific to area of responsibility and manage to the approved budget throughout the fiscal year
Skilled in interpersonal relations with the ability to interface at all levels
Ability to build and maintain team’s dynamics so as to achieve consistent collaboration throughout the Ethics and Compliance department
Ability to develop individuals
Strong risk management process and risk assessments skills
Bachelor's degree required, Master’s degree preferred
At least five (5) years of demonstrated leadership skills and experience in coding operations or compliance management (or equivalent consulting experience) for a large healthcare organization
Strong people management and good communication skills are essential

Coding Compliance Analyst Resume Examples & Samples

Audits EPIC work queues and paper charge tickets, reviewing documentation for correct coding
Focus on accuracy of CPT and ICD-9-CM coding used in all aspects of compliance audits and charge capture
Applies knowledge of CPT, ICD9-CM, HCPC regulations during review process
Utilizes strong proficiency of Federal, State and Commercial payor regulations in performance of audits, and uses strong communication skills to interact real time with staff and providers
Performs and communicates corrections and addendums of electronic medical records to apply HCC rules as indicated through standard work processes
Education of staff and providers with results of monitoring interface systems including, but not limited to: Epic, Softlab, Provation, Mosaiq, in front end and post review process
Work on line and paper charges for compliance and correct coding
Identifies and solves coding problems prior to charge entry to ensure correct coding for physicians and The Everett Clinic
Educate physician and clinical staff on appropriate documentation as required by medical review
Educate physicians, clinical and business services staff on EPIC and manual charge capture
Institute and educate on all annual coding updates for CPT and ICD-9-CM
Corporate Compliance/Peer Review audit includes review of documentation and reporting of any coding or billing problems to the Coding and Compliance Manager for follow-up and new physician monthly meetings
Participate in special audits as instructed under the compliance yearly work plan or as identified throughout the year as areas of concern
Interfaces with clinical and ancillary departments to answer coding questions and clarify new issues or services
Assist Business Services with billing problems that are identified through system edits or denials
Follow-up with physician education and review
Minimum of three (3) years coding experience required; minimum of one to two years’ experience in clinical setting or healthcare business office setting preferred
Must have strong Medical Terminology background
High level understanding of CPT, ICD-9, HCPC coding guidelines
Strong background across a wide range of medical record review processes, including: Evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
Sound knowledge of: CCI (Correct Coding Initiative), insurance regulations (i.e., Medicare, Labor and Industries, Welfare) and regulatory compliance issues
Excellent time management, decision-making, organizational and communication skills
General interpersonal skills to work as a team member and independently
Ability to use various Microsoft Suite software and other applications such as: Outlook, Word, Excel, EPIC, PowerPoint, Codelink and other software applications as required
Ability to work directly with physicians and clinical staff in an educational and resource role
Ability to analyze, problem solve and make appropriate decisions in performance of compliance audits
Requires the ability to establish priorities and coordinate several activities at the same time

Coding Compliance Educator Resume Examples & Samples

Under the general supervision of the Chief Compliance Officer, maintain and participate in performing annual compliance audits or any other focused audits based on OIG work plan, RAC audits, or other specific focus areas
Develop and assist with educational materials for providers and staff on CPT, ICD-10, HCPCS, and RAF scores, as well as with federal and local healthcare regulations, reimbursement policies and procedures
Conduct classroom and individual training/education of coding, reimbursement and payor guidelines to providers and staff
Present audit results and research in both formal and informal educational sessions
Develop relationships with clinical providers and communicate coding and documentation guidelines and requirements to ensure correct coding and documentation
Provide compliance-related documentation and coding guidance support to operational departments
Review specific aberrances and any atypical billings. Exercise good judgment in decision-making regarding audits of those findings
Review reimbursement tools for coding / policy additions, revisions and deletions (encounter tickets, forms, job aids and any other items as deemed necessary) and distribute, as applicable, to providers and staff
Assist with primary and specialty area assessments: identify potential risks to the organization; ensure compliance to policies and procedures, payer regulations and coding guidelines; review all applicable templates; and analyze denied services and adherence to Federal/local guidelines
Maintain current knowledge base with CMS/Federal guidelines (Federal register, transmittals, policies etc.) along with private payer guidelines
Maintain current knowledge of coding guidelines and relevant Federal regulations through the use of current ICD-10 CM book, and other pertinent materials
Maintain strict confidentiality based on organizational privacy and peer review policies

Auditor, Coding Compliance Educator Resume Examples & Samples

3-5 years of direct outpatient coding experience with at least 1 year experience coding for a medical specialty practice required
Experience developing and conducting training/education sessions for diverse audiences
Experience conducting medical coding audits and quality performance measures; preparing audit reports with recommendations; and providing education and feedback to facilitate improvement in documentation and coding

Field Director, Coding Compliance Resume Examples & Samples

Plans, organizes, directs, coordinates and conducts internal coding audits and staff education to assure coding accuracy and compliance
Coordinates facility visits for auditing and acts as team leader when assigned. Reviews all pre-visit information and identifies specific priority focus processes for survey
Utilizes the Patient Tracer Methodology to assess and evaluate a hospital’s compliance with standards and requirements and systems of providing care and services. Reviews and analyzes documents such as policies and procedures, meeting minutes, committee reports, Governing Board meeting minutes, Quality Council meeting minutes, etc. to assess compliance to JCAHO standards, Kindred policies and other licensing agency requirements
Provides “on the spot” consultation and training related to findings. Conducts daily briefings and closing conference with the leadership team
Completes accurate, organized written reports of observations and findings in a timely manner. Assists in aggregating and analyzing findings by facility and division
Reviews and revises tools and processes as needed (reviews at least annually)
Provides consultative services and serves as an expert resource for division, region and facility leadership in the areas of quality, regulations and coding
Assists division in identifying the need for policy and procedure revisions
Conducts Regional and/or Divisional meeting presentations and education on various subjects including summary of audit findings and quality improvement. Knowledgeable of and utilizes adult principles of learning
Maintains current knowledge of coding standards, regulatory and licensing requirements, quality improvement methods and division policies and protocols
Monitors Hotline compliance issues for division and if indicated, provides guidance to facility and regional leadership to ensure thorough investigation and correct action
Conducts Compliance investigations when requested
Knowledge and experience in healthcare operations, clinical practice and use of quality improvement methods
Must have general computer skills, including word processing and email applications and the ability to learn various spreadsheet applications for tracking and reporting
Approximate percent of time required to travel: 75%
5 years of recent experience in the health care field
5 years coding and DRG/PPS/auditing experience

Director, Coding Compliance Resume Examples & Samples

3-5 years experience in coding and health information management as typically acquired in eight years is required; including experience in a supervisory capacity, supervising coders or coding related positions in a physician, hospital or clinic setting as typically acquired in approximately four years required
3-5 years experience in researching complex coding compliance issues and questions, and ability to develop effective education programs for adult learners (coders, physicians, nurses) is required
3-5 years Experience working with a governing Board and senior leaders is strongly required required

Coding & Compliance Specialist Resume Examples & Samples

Monitors, researches and implements changes in response to all local, state
Certification in coding of physician services (CPC, CCS-P)
Significant related experience may be considered in lieu of degree with

Manager, Coding Compliance Resume Examples & Samples

Performs coding compliance audits and special projects with minimal supervision
Demonstrates a thorough understanding of complex coding, reimbursement, health information management processes and auditing principles related to coding compliance
Develops compliance audit reports (memo, executive summary, audit findings and action plan)
Provides educational support on coding, billing and documentation of hospital coding services
Demonstrates an understanding of the UB-04 and Remittance Advice as related to charging and payments of billable services
Stays abreast of coding and billing requirements and of the Company and Department policies and procedures to effectively apply this knowledge to complex coding compliance situations
Thinks proactively and recommends action for improving coding compliance
Works with Department leadership to improve Department processes, and to enhance overall compliance posture of the overall organization
Communicates effectively with facility personnel and Company leadership regarding coding and documentation compliance matters
Maintains confidentiality in accordance with legal obligations and the Company Code of Conduct
Performs other Department duties as assigned

Coding Compliance Auditor / Educator Resume Examples & Samples

Minimum of 5 years coding experience and 2 years experience of performing chart audits and feedback/education in a physician practice environment
Advance working knowledge of CPT, ICD-9, ICD-10 and HCPCS coding
Ability to prioritize, manage time efficiently and make independent decisions based on regulatory citation in conducting audits, disclosing audit findings, providing advisory information that impacts operational processes in documentation, coding, charge capture and billing
Effective communication skills at all levels within the organization
Willing to travel in South Bay and Valley areas

Director of Coding & Compliance Resume Examples & Samples

Minimum 7-10 years experience in a physician outpatient clinic business office
Seven years experience in medical coding with thorough knowledge of CPT and ICD-9 coding principles
Substantial previous experience in dealing with Medicare, Medicaid and other applicable rules and regulations
Knowledge in HCC and process in healthcare programs reimbursements
Minimum three years of leadership experience in providing physician education and coder education required
Minimum of one year auditing experience required
CPC, CCS or RHIT certification
Bachelor’s degree in management, health care, or related field

Coding Compliance Administrator Resume Examples & Samples

Associate’s degree
Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), or Certified Procedural Coder (CPC-H) - must be current
Knowledge of Diagnosis Related Groups (DRG) assignment functions and disease processes
Demonstrated literacy in the use of hospital information systems, personal computers, and Window applications required, including but not limited to Microsoft Office applications
Experience with Inpatient and Outpatient coding, including DRG, Ancillary and ED Coding

Coding Compliance Consultant Resume Examples & Samples

Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Associate (CCA)
Certified Compliance Professional (CCP) or other compliance certification
Experience in ICD-10 and CPT coding
Performing professional coding in a clinic and/or hospital setting
Fluency with documentation guidelines and auditing skills
Fluency in CPT-4, ICD-10 coding, and medical billing
Knowledge of multi-specialty coding guidelines
Knowledge of healthcare coding and reimbursement, including industry standard billing rules, Medicare, Medicaid, L&I, and commercial insurance
Certified Professional Medical Auditor (CPMA)
Certified Evaluation and Management Coder (CEMC)
AAPC Specialty Certifications

Coding & Compliance Analyst Resume Examples & Samples

Hold and maintain CPC or CMC
Demonstrated expertise in current multi-specialty CPT, ICD-10, and HCPC coding principles and practices
Thorough knowledge of Medicare/Medicaid and third party coding requirements
Ability to communicate effectively in written and spoken English
Five years health care experience in a physician group practice or other ambulatory care setting
1 year of coding experience for a multi-specialty group

Coding Compliance Auditor / Trainer Resume Examples & Samples

Telecommute option available, must be able to attend meetings and trainings onsite in the Edmonds facility. Must reside in Washington state
A minimum of three years progressive lead or supervisory experience in a Health Information Management Department in a hospital-based acute care facility is required. This must include at least three years of solid ICD-10-CM and CPT coding experience
In-depth knowledge of applying coding guidelines and conventions
Ability to identify and solicit documentation to code the complete clinical picture based on knowledge of disease processes, clinical judgment and interaction with the Clinical Documentation Integrity Program team
Experience coding for a large Acute Care PPS facility

Coding Compliance Specialist Resume Examples & Samples

Assists with compliance auditing process, including developing audit plans, conducting audits or managing the conduct of audits, reporting results and making recommendations for improvement
Assists in the development of education & training programs
Monitors Federal and local statutes and regulatory changes and makes recommendations for process improvement
Researches and analyzes compliance issues utilizing various publications including extensive use of the internet, the Federal Register, the Medicare Carriers Manual, and other industry publications; makes recommendations for process improvements, and monitors corrective action plans
Five to seven years related experience required; billing office experience highly desirable
Bachelor’s degree preferred in healthcare, business, communications, education law or related field
Certification in coding or compliance from a nationally recognized organization or ability to sit for certification within six months

Coding Compliance, Assistant Manager Resume Examples & Samples

Must have a minimum of (3) three years coding experience in a healthcare setting; or an equivalent combination of education and experience
Prior experience as a lead, supervisor, or manager in a healthcare setting
A Bachelor's Degree; or equivalent combination of education and experience
Credential by A.H.I.M.A. with either R.H.I.A., R.H.I.T. or C.C.S. American Health Information Management Assoc. (AHIMA)
Possess personal characteristics of professionalism, credibility, commitment to high standards, innovation, discriminating judgment and accountability
Must have excellent communication skills with the ability to communicate clearly both verbally and in writing and be able to articulate complex ideas for all levels of audiences
Must be a self-starter who is accountable and requires minimal direction and supervision; person who is visible, accessible, and open to new ideas; and a creative and flexible individual who is comfortable working in a large, complex organization

Hospital Billing & Coding Compliance Mgr Resume Examples & Samples

Six (6) years of recent experience in coding and auditing hospital claims for hospital billing
Recent experience as an educator of medical coding and documentation
A Bachelor’s Degree in relevant field; or equivalent combination of education and experience
Coding certifications (at least one or more), such as: CPC-H, CCS, CCA; and/or Advanced training: RHIT, RHIA, RN, or equivalent degree
Proven in-depth knowledge and ability to comprehensively review patient records for medical documentation of CPT4, ICD9, ICD10 coding and DRG assignment
Ability to review, interpret and explain regulatory bulletins and technical coding information in a clear and effective manner
Proficient computer skills (e.g., MS-Office, Excel, Power Point, Publisher)
Demonstrated ability to provide training to others
Ability to produce, present and interpret detailed billing activity reports
Effective interpersonal and communication skills (oral and written); proficiency in preparing communication materials
Certified ICD-10 proficient or certified ICD-10 trainer
Proven proficiency in using Epic E.H.R. and other information systems

Inpatient Coding Compliance Auditor Telecommute Resume Examples & Samples

5+ years Inpatient Coding Experience
5+ years of Inpatient Audit experience
Certified Coding Specialist (CCS)
Familiarity with the revenue cycle as it relates to inpatient coding, auditing and billing
Extensive experience with various documentation and Electronic Medical Records
Extensive experience in all Inpatient chart types and in high level trauma facilities
Industry Knowledge of Medicare regulations and payment policies, including IPPS
Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) is a plus

Auditor, Coding Compliance Resume Examples & Samples

3-5 years of direct outpatient coding experience with at least 1 year experience coding for a medical specialty practice required
Experience developing and conducting training/education sessions for diverse audiences
Experience conducting medical coding audits and quality performance measures; preparing audit reports with recommendations; and providing education and feedback to facilitate improvement in documentation and coding

Coding Compliance Analyst Resume Examples & Samples

In conjunction with the Assistant Director, develop and deliver role-specific training for HIM Coding staff, develop and implement effective monitoring, auditing and risk assessment activities
Manage or conduct audits, and ensure they are performed in accordance with the UW Medicine Audit Policy
Coding and documentation expertise in either inpatient or outpatient facility coding
Proven communication, organizational, analytical and critical thinking skills
Successful experience in working both independently and in teams
Ability to communicate effectively with all levels of management and medical staff
Demonstrated excellence in developing education for healthcare professional
Experience and proficiency with Epic and/or Cerner

Coding Compliance Auditor Resume Examples & Samples

Performs coding audits reviewing for compliance and accuracy with CPT, ICD-10, HCPCS and corporate coding policy and follows up for timely completion within designated time period
Maintains excellent documentation of all reviews, methodologies employed, results, corrective actions implemented, and monitoring
Assists in focused review projects including data analysis, reporting, and corrective action identification and roll-out
Reports findings, identified trends and risks to the Compliance Auditing Director
Participates in the departmental meetings and provides compliance knowledge and background as required
Assists the Compliance Auditing Director with the development of policies and procedures for the compliance audit program
Prepares monthly, quarterly and annual reports for and as directed by the Compliance Auditing Director
Establishes and maintains cooperative working relationships with the corporate management team, physician practices and all staff members to provide expertise and compliance training as needed
Performs additional administrative duties as assigned by Compliance Director or senior management
Coding background
Healthcare background or training and a deep understanding of medical chart requirements
CPC or equivalent required
Prior medical office management experience
Ability to set up conference calls and facilitate call to discuss audit results
Ability to exercise initiative, use sound judgment and employ effective problem solving techniques in the decision making process
Self-starter, self-directed, team oriented with the ability to meet deadlines
Computer skills – word, spreadsheet (Excel), practice management systems and reporting, Internet research experience
Ability to handle confidential information with the utmost discretion
Strong business verbal and written communication skills required
CPC Certification or commensurate experience
CPMA Certification or willing to obtain CPMA Certification within one year of employment

Coding & Compliance Specialist Resume Examples & Samples

Reviews medical records to determine accuracy of billing through verification of coding, billing and supporting clinical documentation
Coordinates all activities associated with insurance carrier audit requests and works with payers to ensure timely handling of these payer audits
Reviews technical payer denials and determines whether an appeal is justified. Writes and tracks technical appeal letters and relay information with billing department
Conducts audits to ensure accurate charge capture, enhance reimbursement and identify savings potential
Minimum five (5) years of experience directly applicable to the primary work required

Coding Compliance Educator Resume Examples & Samples

Professional coding certification through AHIMA or AAPC
Hands-on audit experience in documentation and coding of physician services
Advance knowledge of government, legal and regulatory provisions related to documentation and coding audit
Advance knowledge of Federal Programs and commercial payor documentation and coding requirements
Advance analytical skills in documentation and coding audit results for root cause analysis, corrective plan of action, forecast and developing future audit process and strategies
Proficiency in MS Office and EMR
Reimbursement/billing experience preferred
4-year degree preferred

Manager, Coding Compliance Resume Examples & Samples

Performs outpatient audits projects with minimal supervision
Demonstrates a thorough understanding of complex coding, reimbursement and health information management processes and auditing principles related to outpatient settings
Demonstrates an understanding of the UB-04, detailed bill and detailed Remittance Advice as related to charging and payment for outpatient services
Communicates with Department leadership and facility management teams regarding outpatient coding and billing issues and regulations
Keeps informed regarding current coding regulations, professional standards, and Company/Department policies and procedures, and effectively applies this knowledge
Analyzes medical records and coding and documentation information, identifies issues, reaches conclusions, and proposes strategies for resolution of coding issues
Has a working knowledge of chargemaster functions
Prepares working papers, reports and memoranda regarding coding compliance matters and audit results
Develops, organizes and maintains spreadsheet data or worksheets related to coding and documentation compliance
Coordinates scheduling to meet Department work plan requirements while maintaining audit accuracy
Manages specific area of expertise including research, keeping abreast of changes, and informing/educating other outpatient coding compliance team members
Manages audit engagements including managing his/her individual time, scheduling work and monitoring the progress of assigned audits
Serves as a trusted business advisor by providing facility personnel with professional advice and best practice information regarding coding and billing compliance
Mentors staff and other Department personnel at the request of Department leadership
Provides input and guidance in the development and review of detailed audit programs and reports to improve audit effectiveness and efficiency
Assists in developing and executing Department educational plans related to coding matters, working in conjunction with the Director of Compliance education
Reports to Company leadership including the Chief Compliance Committee on matters related to coding compliance, as directed by Department leadership
Maintains coding expertise in outpatient coding and billing, including research, keeping updated on regulatory changes, and informing/educating other coding compliance team members
Undertakes continuing education to maintain technical coding, HIM, auditing and management skills consistent with the Company and Department’s professional development requirements and individual credentials
Maintains confidentiality in accordance with legal obligations and the Company Code of Conduct and the Code of Ethics for Healthcare Professionals adopted by the Health Care Compliance Associate

Manager, Coding Compliance & Projects Resume Examples & Samples

Manage direct reports’ day-to-day operations and projects; facilitate team weekly training to promote continuous and on-going education in ICD-CM coding compliance and strategies
Responsible for hiring, training, coaching, reviewing job performance and counseling all coding analyst staff, including initiation of corrective action plans as necessary
Interface with operational and clinical leadership to assist in identification of clinical documentation improvements and promote clinical best practices in understanding clinical suspects and monitoring of appropriate documentation and quality coding
Meet with selected provider network groups to update them on the chart review compliance and improvement efforts
Create strategic plan as it relates to implementation of departmental policies and procedures, and be responsible for implementation of processes as they relate to the strategic plan
Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers’ performance levels
Responsible for educating and keeping management informed on current changes in regulations as related to coding, billing and documentation
Creation of relevant and timely provider education articles for the Healthfirst-The Source monthly publication
Support the Clinical Quality teams in the development and implementation of provider education training and presentations to assist in maintaining and/or improving Healthfirst HEDIS, QARR, STARS and other publicly reported ratings
Certified Coder (AHIMA or AAPC)
ICD-10 Training experience
Data Analytical Experience
Knowledge of Medicare, Medicaid and Affordable Care Act regulatory requirements Knowledge of risk adjustment models
Coding Training and Provider Education Experience
Ability to create provider education material, including writing articles
Clinician (e.g., RN, LPN, PA)
Claims Experience

Senior Coding Compliance Auditor, Admin Resume Examples & Samples

Minimum 5 years professional experience in healthcare environment related to coding, auditing &/or billing compliance
Minimum 3 years experience coding, medical record documentation auditing in an ambulatory care multi-specialty setting
Excellent working knowledge of CPT, ICD-10 and HCPC codes and their use
Thorough understanding of Medicare, Medi-Cal and other payor documentation, coding, billing and compliance requirements
Experience related to the development of training material and presenting to a population up to 50 people
Bachelor's degree (or equivalent education, training and experience)
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P)
Strong knowledge of healthcare regulatory requirements associated with coding rules and guidelines as well as Medicare and Medi-Cal documentation and billing requirements
Excellent organization, analytical, verbal and written communication skills required
Professional approach to work, including ability to exercise sound judgment and maintain confidentiality in all activities required
Proficient with Excel, Word, and PowerPoint computer programs
Experience with electronic medical record systems (EMR) and in-depth knowledge and understanding of system documentation and coding processes
Working knowledge of coding audit management software
Cert Coding Specialist (CCS) , Certified Prof. Coder

Coding Compliance Auditor Resume Examples & Samples

Ability to read, analyzes, and interprets common and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information to top management and/or payers
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
Ability to define problems collects data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

Coding Compliance Semi-annual Review Manager Resume Examples & Samples

Provides input regarding departmental budget specific to area of responsibility
Reviews and approves expense reports for direct reports
Thorough knowledge of Official Coding Guidelines, Federal and State coding regulations, payor specific coding rules, and third party billing requirements and ability to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed
Consistently exercises discretion and independent judgment when performing and documenting audit results
Advanced knowledge of disease pathophysiology and drug utilization
Advanced knowledge of MS-DRG & APR-DRG classification and reimbursement structures
Documented experience in inpatient and outpatient coding, coding compliance auditing, and coder training
Bachelor/Associate degree and AHIMA coding credential