Coding Compliance Auditor
$92,601,600–$117,832,000 year
On-siteFresno, California, United States
Fresno, California, United StatesOn-siteFull Time$92,601,600–$117,832,000 yearSenior LevelAssociates DegreeMedium
Full TimeSenior LevelAssociates DegreeMedium
Job Summary
Conduct coding and documentation audits to ensure accurate code assignment, appropriate billing, and compliance with federal and state healthcare program requirements. Audit both facility coding and professional fees for partners, as well as review other coders and physicians for charge and reimbursement accuracy. Perform medical record reviews focusing on clinical documentation, medical terminology, and codes including CPT, HCPCS, and ICD-10-CM. This role is part of the Compliance Office at Community Health System, a top employer recognized by Forbes and Newsweek.
Required Qualifications
- Associate's Degree in Business, Information Systems, Nursing, Health Care, or a related field
- Experience performing medical record and billing audits/reviews, including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM, and revenue)
- Knowledge of federal, state, and private payer guidelines
- 5 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS
- 3 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS
- CCS - Certified Coding Specialist
- CCS-P - Certified Coding Specialist- Physician-based
- CMAS - Certified Medical Audit Specialist
- CPMA - Certified Professional Medical Auditor
- CPC - Certified Professional Coder
Desired Qualifications
- Bachelor's Degree in Business, Information Systems, Nursing, Health Care, or a related field
- Epic experience
- Experience with 3M or Optum
- Experience completing a formal validation report after completing audits
- RHIA - Registered Health Information Administrator
- RHIT - Registered Health Information Technician
- Two or more certifications
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