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POSITION DESCRIPTION:

The Compliance Auditor/Educator serves as the

subject matter expert and as a point of contact for IHA offices and Revenue Department for proper coding procedures and workflow for existing medical services.  Provides professional expertise and education in CPT, ICD and HCC coding.  The Compliance Auditor/Educator is responsible for professional development of educational materials, clinical case studies, guidelines and job aides to provide direction and guidance across IHA departments and offices for coding and documentation regulations.  This role is also responsible for responding to compliance-related coding and documentation issues via the event reporting system and managing them to proper resolution.  Performs medical record integrity audits and conducts one-on-one meetings with

Providers for corrective educational guidance.     

ESSENTIAL JOB FUNCTIONS:

Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies problems and uses professional judgment and independent assessment.

Reports audit results utilizing a standard reporting process. Performs thoughtful and multi-layered consideration of medical decision-making in relation to the nature of the presenting problem and clinical documentation.

Identifies new errors while performing audits, investigates and assesses the root cause of errors and develops corrective action plans. 

Performs one-on-one Audit Meetings with Providers for corrective educational guidance; develops corrective action plans and related educational materials. 

Assists in the planning, organizing and completion of auditing activities required to comply with federal payers and other compliance-related requirements.

Researches federal, payer coding and documentation requirements and develops comprehensive written processes and guidelines for correct coding tailored to specific situations and encounters.  Performs critical analysis to apply complex coding rules to specific work processes and develops thoughtful, multi-layered recommendations and adjustments to office and department work flows to better comply with the standards. 

Monitors audit trends to identify errors in coding and documentation, lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation,

reports findings. Recommends process improvement strategies to IHA offices and departments. Monitors to completion.

Educates

Providers on correct coding principles and works with

Providers to increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles.

Serves as a [subject matter expert in all areas of coding, documentation and audits. Acts as a key contact for Providers, Revenue Department and Managers for coding questions.  Works as the liaison between multiple departments to provide guidance, service as the []{grayt-phrase="subject matter expert

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