Coding Compliance Resume Samples

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MU
M Upton
Marty
Upton
846 Linwood Ville
Chicago
IL
+1 (555) 153 5534
846 Linwood Ville
Chicago
IL
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
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
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11 Coding Compliance resume templates

1

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
2

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
3

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
4

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
5

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
6

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
7

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
8

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
9

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
10

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
11

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
12

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
13

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
14

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
15

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
16

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
17

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
18

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
19

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
20

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
21

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
22

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
23

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
24

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
25

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
26

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
27

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
28

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
29

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
30

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
31

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
32

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
33

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
34

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
35

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
36

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
37

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
38

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