Sr Coding Compliance Auditor
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AI Summary
Conduct comprehensive audits of financial records and regulatory compliance to ensure accurate HCC diagnosis reporting and mitigate fraud. Partner with quality teams and payers to identify trends, resolve claims denials, and enhance operational efficiency.
Where You’ll Work
CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.
Job Summary and Responsibilities
As our Auditor, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility.Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making.To be successful, you’ll combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements.- Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims.
- Works to resolve claims denials and reports denial trends to leadership
- Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients’ chart note.
- Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures.
- Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process.
- Assists in the development and reporting of HCC and Pay for Performance metrics.
Job Requirements
Required- five years physician coding experience and
- Certified Rehabilitation Counselor, within 12 - months and
- Certified Professional Coder Hospital Apprentice, upon hire or
- Certified Professional Coder Apprentice, upon hire or
- Certified Coding Associate, upon hire or
- Cardiology Coding, upon hire or
- Certified Coding Specialist, upon hire or
- Certified Coding Specialist - Physician Based, upon hire or
- Certified Cardiovascular and Thoracic Surgery Coder, upon hire or
- Certified Health Care Compliance, upon hire or
- Certified Interventional Radiology Cardio Coder, upon hire or
- Certified Professional Coder, upon hire or
- Certified Professional Coder Hospital, upon hire or
- Radiology Certified Coder, upon hire or
- Registered Health Information Administrator, upon hire or
- Registered Health Information Technician, upon hire and
- Associates Other, upon hire and
- three years experience performing diagnosis, E/M, and procedure code audit/review/education functions for professional fees in multi-specialty setting
- Registered Nurse: TN, upon hire or
- Licensed Practical Nurse: TN, upon hire or
- Certified Nursing Assistant: TN, upon hire or
- Certified Professional Medical Auditor, upon hire
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