Coding Compliance Resume Sample

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Kody Konopelski
98672 Jermain Fort,  Los Angeles, CA
+1 (555) 271 0569

Work Experience


Manager, Coding Compliance
03/2018 - PRESENT
Detroit, MI
  • 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
  • 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
  • Perform ongoing quality checks and reviews of Health Information Management (HIM) coded medical records
  • Provide feedback to coding staff and management on coding accuracy and completeness, inclusion of admission indicators, and accuracy of discharge disposition
  • Work collaboratively with the Clinical Documentation Information Program (CDIP) to ensure that coding decisions support reimbursement for the level of service provided. If a coder and the CDIP do not agree on coding classification for a particular record, works with management to make a final determination to classify that record
  • Respond to and track requests for Diagnosis Related Groups (DRG) changes from third party payers per procedure
  • Communicate with coding staff on an ongoing basis to insure that coding updates, changes or procedures are disseminated through appropriate channels
  • Assist management with hiring decisions by assessing the coding skills of applicants applying for coding positions. Provide ongoing input and recommendations to management regarding performance of the coding team
Coding Compliance Auditor
03/2011 - 12/2017
Los Angeles, CA
  • Develop training curriculum and conducts department orientation for new hires. Develop curriculum and delivers training to existing staff to ensure coding profiency in all patient types
  • Create and execute test plans, builds test data, and tests new or enhanced application functions and upgrades, and create new source documents and end-user documents
  • Assist management in developing and maintaining coding and abstracting policies, procedures and guidelines. Provide input as requested regarding budgeting, expense management, quality, and departmental regulatory compliance
  • Support and provide compliance and coding training to physicians, clinic staff and corporate auditing and billing staff
  • Perform medical records audits according to corporate compliance and coding plan, and provide immediate feedback and training to appropriate physician and support personnel
  • Prepare reports of audit results, including recommendations
  • Create educational materials for coding training and education
  • Participate in review of specialists’ claims
Coding Compliance Educator
10/2006 - 02/2011
San Francisco, CA
  • Act as a resource for Coding and Coding Compliance Specialists
  • Education of staff and providers with results of monitoring interface systems including, but not limited to
  • Ensure providers have a compliance plan and policies and procedures that detail provider expectations. Review, monitor and report on providers' effective implementation of the plan
  • Consistently and accurately audit coding of inpatient and outpatient encounters
  • Create clear and concise audit reports and maintain productivity standards
  • Knowledge of medical terminology, ICD-9/10 CM/PCS, EM, and CPT-4 coding guidelines and methodologies
  • 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
  • Assist Business Services with billing problems that are identified through system edits or denials. Follow-up with physician education and review
  • Reviews medical record for proper assignment of diagnoses and procedure codes according to AMA, ICD-9-CM, CPT, and OIG Guidelines

Education


University of Phoenix - Wichita Campus
2001 - 2005
Bachelor's Degree in Business

Professional Skills


  • Coordinate meetings, develop meeting agendas, assign audit deliverables with coding staff; meet with coding staffs to determine other information needed to complete the internal or external audits
  • Excellent time management, decision-making, organizational and communication skills. General interpersonal skills to work as a team member and independently
  • Good interpersonal skills to deal effectively and courteously with business-related associates and staff members required
  • Auditing and coding experience with 1-2 years’ experience in medical auditing and educating
  • Seven (7) years of experience in auditing or similar related experience required
  • Knowledge of Microsoft Office Suite including PowerPoint, Excel and Access; internet research skills
  • Experience educating & training physicians on coding, billing and documentation standards

How to write Coding Compliance Resume

Coding Compliance role is responsible for coding, audit, compliance, research, auditing, microsoft, education, retail, training, oncology.
To write great resume for coding compliance job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Coding Compliance Resume

The section contact information is important in your coding compliance resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Coding Compliance Resume

The section work experience is an essential part of your coding compliance resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous coding compliance responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular coding compliance position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Coding Compliance resume experience can include:

  • Billing and coding experience within a physician’s setting
  • Demonstrates the ability to manage multiple projects
  • Utilizes CCI, CPT, ICD-9, HCPCS, coding manuals, Medicare and CMS Policies to ensure correct coding while maximizing reimbursement
  • Understands internal coding, auditing and Coding Compliance Education plans and appropriately applies concepts
  • Understands SMG internal coding, auditing and Coding Compliance Education plans and appropriately applies concepts
  • Maintains high level of specialty specific coding and auditing guidelines

Education on a Coding Compliance Resume

Make sure to make education a priority on your coding compliance resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your coding compliance experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Coding Compliance Resume

When listing skills on your coding compliance resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical coding compliance skills:

  • Experience creating and editing presentations using Microsoft PowerPoint
  • Work experience within a medical record and coding auditing setting
  • Coding experience for a multi-specialty group and a score of at least 90% on PMC’s Coding Competency Test
  • Three (3) years coding experience including but not limited to hospital inpatient and outpatient encounters
  • One (1) year of experience in coding audit or quality review work including but not limited to hospital inpatient and outpatient encounters
  • Multi-task, organize & prioritize work within any given setting

List of Typical Experience For a Coding Compliance Resume

1

Experience For Coding Compliance Auditor Resume

  • Professional services coding/billing/auditing experience in pediatric environment
  • Work experience in a supervisory role for medical records or in a coding setting
  • Experience communicating and presenting to cross functional groups within an organization
  • Conducts regular coding audits and coordinates ongoing monitoring of coding accuracy, providing continuous feedback to coding staff
  • Conducts Compliance reviews for purposes of identifying, assessing, and documenting
  • Provides on-going training and education to coding staff
  • Develops and coordinates educational sessions to all coding staff regarding documentation and accurate coding
  • Maintains current knowledge of advances in Coding, Auditing and Compliance
2

Experience For Manager, Coding Compliance Resume

  • Performs initial new provider audit reviews (20+charts), formally logging and communicating findings
  • Communicates and meets regularly with Providers and staff regarding coding changes, compliance issues and education
  • Ensure diagnosis reporting meets all AMA, ICD-10-CM, HCC, Risk Adjustment Reporting, and CMS Guidelines as per in-house process
  • Participates in the onboarding/orientation of new providers as it relates to coding and reimbursement
  • Serve as an expert resource to research and respond to challenging coding questions
  • Conduct adhoc coding and billing compliance audits as requested
  • Abstracts required data from the medical record, including, but not limited to ICD-9-CM, CPT, units, sites, modifiers, HCPCS, drugs, supplies, etc
  • Works with other Departments to address basic coding and documentation questions and/or issues
  • Review of practice activity and physician compensation reports for areas of needed education or potential coding enhancement
3

Experience For Coding Compliance Manager Resume

  • Performs annual compliance practice audit analysis reviews 10 chart random auditing based on noted bell curve areas of concerns
  • Performs Provider focused Compliance Audit Reviews as outlined in Coding Compliance Education Plan
  • Performs Level 5 audits review, logging and monthly compliance summary reports
  • Work with Manager in developing Provider and staff education programs
  • Maintains logs, summary of auditing results and communicates findings to Manager
4

Experience For Coding Compliance Analyst Resume

  • Coordinates and/or communicates annual coding releases from AMA (ICD-9-CM, CPT, HCPCS) OIG and CMS
  • Reviews medical record for proper assignment of diagnoses according to AMA, AHA, ICD-10-CM Guidelines
  • Reviews all Wellness Program documents and plans to ensure coding compliance
  • Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association
  • Formally logs audit findings and tracks appropriate required follow-up based internal guidelines
  • Provides education to Physicians and other staff on appropriate documentation needs
  • Audits medical records to clarify CPT, diagnoses & procedures
5

Experience For Coding Compliance Educator Resume

  • Identifies logs and communicates patterns and trends found in Audit Reviews
  • Recognizes and reports problems, errors and discrepancies in medical records
  • Maintains a current level of OIG, Compliance, CMS, Stark, and Fraud & Abuse Regulations
  • Identifies lost reimbursement due to lack of appropriate documentation in order to educate Provider accordingly to achieve maximum reimbursement and compliance
  • Meets productivity standards and turnaround times
  • Carrier audits -- coordinates needed resources and documentation, logs findings and follow-up with Provider education refunds and appeal requests
  • Utilizes practice management system and other system applications to run reports, work claims for audit reviews. Correct claims accordingly and release claims for billing
  • Works with Providers to address and resolve documentation deficiencies
  • Provides monthly provider compliance/education summary reports to Manager
6

Experience For Manager, Coding Compliance & Projects Resume

  • Analyze data, maintains designated production standards, and organize multiple projects and tasks
  • Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates patterns and trending analysis based on performing review and alerting the Manager and/or Director of any areas of identified concern
  • Maintains high-level of specialty specific coding and auditing guidelines
  • Review of physician compensation reports UPIP for areas of needed education or potential coding enhancement
  • Utilizes logs to Identifies and communicates patterns and trends found in Audit Reviews
7

Experience For Field Director, Coding Compliance Resume

  • Understands and implements the MEAT concept
  • Prepares written reports of audit findings to present to Manager, Physicians or other parties
  • Assist Management with special HCC projects as assigned
  • Performs potential compliance coding investigations. Creates detailed case reports of fraudulent and abusive activities. Submits findings from detailed analysis and makes recommendations to Compliance Officer. Participates in internal SIU Team Meetings
  • Analyzes coding/claims data as part of the investigative process using fraud detection software provided by vendor and collaborate with vendor SIU on cases when necessary. Organization and maintenance of coding compliance reports generated from software tool
8

Experience For Coding Compliance Consultant Resume

  • Conducts data mining activities, data analysis and reporting using available tools and internal data warehouse
  • Collaborates with internal departments on routine internal monitoring of healthcare coding conventions
  • Review, interpret, and disseminate federal, state, and industry rules and regulations in regard to coding compliance. Obtains all data needed to assure compliance with regulatory agencies. Keeps current with all standard coding practices, Medicare Advantage Fraud, Waste and Abuse guidelines
  • Assists in the development and implementation of organizational measures and policies and procedures to prevent, detect and correct coding compliance issues. Collaborates with senior management and leadership to ensure organization remains in coding compliance. Performs compliance related coding audits as assigned
  • Assists with the creation and delivery of formal and informal education related to coding compliance. Participates in meetings as assigned
  • Prepares and presents coding compliance reports to the Medical Economics Team (MET)
  • Reviews organizational Medical Policies to ensure coding compliance
  • Chairs the internal code review committee and organizes and leads topic specific work groups. Chair the external Medicare Update/Transmittals Committee
9

Experience For Senior Coding Compliance Auditor, Admin Resume

  • Ensures review findings are clear and accurate; responsible for reporting audit trends as an opportunity for coder/auditor education, training, and corrective actions. Uses findings to advise on policies, processes, and training for overall improvement in coding and auditing quality and related functions
  • Serves as resource for other coding compliance team members, including directors and other managers. Collaborates with Manager of Coding Compliance Education for developing and presenting educational sessions to all coding and auditing staff, and responsible for all training and menoring of new and existing staff
  • Oversee all functions of the billing and medical record’s department
  • Perform consultations with departments and medical providers to enhance billing functions, performance, accuracy, documentation requirements, and all other system requirements
  • Proficient with medical terminology at college level with the ability to understand disease processes, anatomy and physiology necessary for assigning accurate numeric and alphanumeric codes
  • Experience with and knowledge of instructional notations and conventions of ICD-9-CM, ICD-10, CPT, HCPCS, APC classification systems; the ability to follow the detailed guidelines related to their use in assigning single and sequencing multiple, diagnosis and procedure codes for appropriate the reimbursements and data collection
  • Develop strong working relationships with others
  • Work with, communicate to, and present to a diverse work force in all levels of the organization
  • 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
10

Experience For Hospital Billing & Coding Compliance Mgr Resume

  • Leads efforts to develop individualized, collaborative, comprehensive compliance programs for the organization’s key service lines including, but not limited to: Hospital Revenue Cycle, Physician Revenue Cycle, and Consumer Protection
  • Consistently collaborates with peers to ensure appropriate support is provided by his/her own area(s) to promote the success of the other areas of the organization’s Compliance Program
  • Serves as resource for other coding compliance team members, including directors and other managers. Collaborates with Manager of Coding Compliance Education for developing and presenting educational sessions to all coding and auditing staff, and responsible for all training and mentoring of new and existing staff
  • Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding
  • 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

List of Typical Skills For a Coding Compliance Resume

1

Skills For Coding Compliance Auditor Resume

  • Experience in Auditing or Coding in multi-specialty groups or similar related experience
  • Five (5) years of health care experience in a physician group practice or other ambulatory care setting
  • One (1) year of coding experience for a multi-specialty group
  • Experience conducting provider education and audits
  • Demonstrated expertise in current multi-specialty CPT, ICD-9, and HCPC coding principles and practices
  • Evaluation and management (E/M) coding experience
  • Experience in ICD-10-CM and CPT coding
2

Skills For Manager, Coding Compliance Resume

  • RHIT or RHIA (or eligibility), or equivalent experience
  • Valid Washington State Driver’s License and current auto insurance
  • Medical coding experience
  • Three years of experience in revenue cycle management in a physician practice
  • Plan work and establish priorities required
3

Skills For Coding Compliance Manager Resume

  • CCS: Certified Coding Specialist Certification and three years of coding experience
  • Successful experience in working within a multifaceted, highly matrixed organization
  • Demonstrate proficiency in the application of nationally established coding
  • Experience with 3M encoder
  • Understanding of Medicare and Medicaid risk adjustment regulations and guidelines
  • Willing to travel up to 10% as needed
4

Skills For Coding Compliance Analyst Resume

  • Auditing of Facility Coding (ER, OPS, OBS, Ancillary, Recurring Therapy, Clinic, etc.)
  • Auditing of Coding Edit Resolution
  • Auditing of Professional Coding
  • Working knowledge of the HIPPA Privacy Regulations
  • Identifies trends and reports to Coding manager
  • One or more of the following certifications (or eligibility)
5

Skills For Coding Compliance Educator Resume

  • Obtain and maintain ACS E/M or CPC-EM or CPMA auditing certification within 6 (six) months of hire
  • At least one other coding specialty certification for Professional Services
  • Knowledge of surgical coding
  • Knowledge of Evaluation and Management coding
  • Complete audit assignments based upon direction received, involve Manager for concerns and problems
  • Monitor developments in related rules, regulations and coding changes; make recommendations to the Assistant Director, as needed, to maintain coding compliance/quality and mitigate risk
  • Conduct proactive risk assessments as directed and report results to Assistant Director
6

Skills For Manager, Coding Compliance & Projects Resume

  • Coordinate with and provide guidance to Compliance, Clinical Documentation Improvement, Utilization Management, Clinical Resource Management and Patient Financial Services on matters involving coding/billing compliance content related issues
  • Completion of coder audit reports of accounts completed daily
  • Completion of Time Allocation reports daily
  • Completion of weekly audit reports for assigned staff
  • Reports weekly statistics of audits completed
  • Endurance to work long hours on projects
  • Process a large amount and distinct types of data
  • Work in confined and/or various workstations
  • Manage people, counsel problem employees, and employee’s work performance in a professional manner
7

Skills For Field Director, Coding Compliance Resume

  • Build and maintain team’s dynamics so as to achieve consistent collaboration throughout the Ethics and Compliance department
  • Certified Professional Coder: CPC, CCS-P or CN-P Coder from AHIMA or AAPC only required
  • Knowledge of Medicare reimbursement methodologies
  • Travel 20% of the time
  • Certified Professional Coder (CPC), Certified Coding Specialist-Physician (CCS-P), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)
  • Credentialed as a RHIA or RHIT. CCS certification (for outpatient services, CPC-H is acceptable)
  • Certified professional coder status required (CPC)
  • Manipulate data in spreadsheets (i.e. Microsoft Excel) in order to report trends/patterns/statuses or abuses to supervisor. Ability to communicate using word processing software (i.e. Microsoft Word)
  • Substancial previous experience in dealing with Medicare, Medicaid and other applicable rules and regulations
8

Skills For Coding Compliance Consultant Resume

  • Knowledge of CMS, Medicaid and other regulatory guidelines including current Evaluation and Management documentation and coding rules
  • Knowledge of medical terminology, disease processes and pharmacology
  • Proficient in Excel, MS Word and general PC applications
  • Certified Professoinal Coder ( CPC ) Certification
  • Working knowledge of computers and demonstrated proficiency in using email systems, internet and Microsoft Office software applications with emphasis on MS Word and Excel required
  • An understanding of healthcare billing practices and compliant claims preparation for both governmental and commercial payers
  • Extensive knowledge of ICD-9, ICD-10, CPT and HCPCS coding principles and guidelines
  • For ALL Senior Director positions
9

Skills For Senior Coding Compliance Auditor, Admin Resume

  • CPC certification or equivalent required
  • Eagerness to learn new areas and work with little supervision
  • Work with confidential materials and to juggle multiple tasks
  • Proficiency with MS Office applications and electronic medical records systems
  • Revenue Cycle Certifications: The following are recognized professional certifications: Certified Professional Account Representative (CPAR), Certified Revenue Cycle Representative (CRCR) or Certified Professional Biller (CPB)
  • Electronic health record (EHR) expertise, including knowledge of a variety of vendors
10

Skills For Hospital Billing & Coding Compliance Mgr Resume

  • Knowledge of computing observation hours
  • Knowledge of coding infusions and injections
  • Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT)
  • Knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS)
  • Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes
  • Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology)
  • Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions
  • Strengthen the CPT and ICD-9 coding associated with the documentation of all services through instructional classes

List of Typical Responsibilities For a Coding Compliance Resume

1

Responsibilities For Coding Compliance Auditor Resume

  • 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
  • Communicates effectively and reports findings to the Coding Manager
  • Tracks corrective action plans related to regulatory impacts, including those identified as a result of compliance monitoring, testing, or audits
  • Participate in audit and coding team meetings to discuss solutions to coding guidance or presentation issues
  • Perform ongoing internal audits of medical record documentation and the correct use of CPT-4 and ICD-9 codes
  • Organizes audit samples and accurately records audit findings using company approved protocols, audit tools and worksheets
  • Review medical records for documentation accuracy and coding compliance
  • Reports audit results and educational opportunities identified to the Coding Manager
  • Participates in coding research
2

Responsibilities For Manager, Coding Compliance Resume

  • Develops and recommends changes as needed to enhance the overall auditing process
  • 9-Sr. Auditor of Coding Compliance
  • Clarifies discrepancies in documentation and reviews coding
  • Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers’ performance levels
  • Using Microsoft PowerPoint software, summarizes and reports pertinent audit findings. Calculates CPT risk, overall practice and individual accuracy rate percentages
  • Presents in an action plan format, recommendations for identified educational opportunities based on audit findings as compared to applicable regulatory, compliance, and correct coding guidelines
  • Along with the Coding Manager, participates in scheduled meetings to present audit findings to the Regional President, Medical Director, Regional Vice President, Vice President of Integration, Coding Education Manager, Coding Educator, and selected clinical and non-clinical associates
  • Assists the Regional Coding Educator by providing the basic audit detail and documents to ensure appropriate communication of audit follow up and coding education. Reviews and answers questions regarding the audit findings in accordance with the QACAP policy
3

Responsibilities For Coding Compliance Manager Resume

  • Identifies and records coding issues
  • Conducts re-audits based on initial audit outcomes
  • Performs miscellaneous compliance audits and company based audit projects as required or requested by senior management
  • Reviews medical record documentation against coded services to determine associated risk or accuracy
  • Performs focused audits on medical records when needed
  • Review as needed, audit documents and templates for recommended revisions
4

Responsibilities For Coding Compliance Analyst Resume

  • Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues
  • Manage all vendors' activities related to risk adjustment audits, which include providing audit samples, the management of vendors' medical record retrievals and chart review workloads inside and out of the organization
  • Conduct periodic (i.e. monthly) risk adjustment workgroups that include case studies and Q&A sessions. Inform the team of all changes/updates made to the risk adjustment model(s), CMS (Centers for Medicare and Medicaid Services) and other regulatory guidance & coding guidelines, and provide clarification as needed
  • Develop and implement processes and workflows around the execution of audits; maintain documentation and chart review audit results consistent with internal standard operational procedures as well as CMS and other governmental regulations and our company's goals and policies
  • Ensure all stored medical records have gone through the internal quality assurance process
  • Certification in American Academy of Professional Coders or American Health Information Management Association
  • Audits clinical documentation, CPT-4, HCPCS, modifiers, ICD-9 and ICD-10 coding to ensure accurate reimbursement and compliance with CMS and third party payer laws and regulations
  • Plans and thoroughly researches topics of audits independently for quality assurance
5

Responsibilities For Coding Compliance Educator Resume

  • Randomly selects (as well as through selected criteria) accounts to review to enhance coding and reimbursement quality and compliance with state and federal payer regulations
  • Utilizes Rat Stats statistical software to ensure appropriate selection of claims
  • Develops complete reports reflecting audit findings including negative and positive trends. Reports findings to Manager or Compliance Coordinator and follows through as directed
  • Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist Certification (CCS) or Certified Coding Specialist- Physician-based (CCS-P) or Certified Professional Coder (CPC), Certified Outpatient Coding (COC)
  • Monitors and evaluates compliance for the ARKS (Anesthesia Record Keeping System) electronic clinical documentation system
6

Responsibilities For Manager, Coding Compliance & Projects Resume

  • Serves as the Institute's primary contact for any compliance related functions/issues
  • Manages and investigates issues that are part of the event log and ensures that a plan of correction is implemented and sustained
  • Identifies reviews, interprets, codes and abstracts clinical information from the medical record for the purpose of reimbursement, research, and compliance with federal regulations and other agencies using established coding principles and protocols
  • Monitors the accuracy and adequacy of the clinical Institutes' reporting of monitoring activities, including performing inter-rater reliability audits throughout the organization
  • Responds to questions and provides guidance regarding billing, coding, medical record documentation standards, guidelines and regulatory requirements to all levels of the organization
  • Performs focus audits including data extraction
  • Trains other coders and provides educational sessions to physicians on coding and reimbursement. Responsible for monitoring new physician documentation to ensure regulatory compliance
  • Develops and presents the annual compliance report for the Institute to CC Executive Leadership. Along with the physician compliance officer, presents the Institute's compliance program to CC Executive Leadership
  • Coordinate monthly compliance reporting from departments and facilitates the Institute's monthly compliance committee
7

Responsibilities For Field Director, Coding Compliance Resume

  • Reviews HIPAA compliance trends and issues for the Institute and provides education, monitors CMS regulatory standards, and represents the Institute by participating in internal/external committees
  • Monitors CMS regulatory standards for documentation compliance
  • Monitors and tracks non-physician education requirements. Acts as a liaison to the quality committee and quality staff
  • Serves as the Co-Chair of the Institute compliance committee
  • Developing and maintaining good communications and working relationships with the medical staff, administrative staff, outside agencies and with other departments
  • Responsible for overseeing all issues related to audit process and completion; manages staff; assigns work accordingly to maximize productivity and instructs in proper auditing procedures
  • Responsible for the creation, maintenance and education of Coding Compliance department procedures and job aides consistent with established Dignity Health policies
  • Acts as liaison between Coding Compliance and Coding Department to address escalated coding scenarios; updates staff accordingly with CMS transmittals, alerts and Med Learn Matters articles
8

Responsibilities For Coding Compliance Consultant Resume

  • Develops, maintains and educates others on audit program to ensure adherence to industry standards, established Dignity Health Medical Foundation policies, and compliance directives
  • Contributes to a fiscally responsible, cost effective department budget
  • Clearly document audit findings and calculate coding and billing error rates
  • Under the direction of the Compliance Director, ensures all regulatory, HIPAA, Health and Safety, and other compliance directives meet standards
  • Ensures organizational goals, benchmarks and objectives meet or exceed standards
9

Responsibilities For Senior Coding Compliance Auditor, Admin Resume

  • Maintains and improves operations through efficient use of organizational resources and systems
  • Responsible for the hire and selection process of new staff in partnership with Dignity Health Medical Foundations policies and procedures
  • Responsible for the coaching and mentoring of department staff including the ongoing performance review process of employees in partnership with Dignity Health Medical Foundation policies and procedures
  • Provides compliance and coding training for new providers during their onboarding processes
  • Ensures staff is monitoring and educating providers during their initial audit review period
10

Responsibilities For Hospital Billing & Coding Compliance Mgr Resume

  • Articulate audit findings appropriate for audience. Prepares written audit reports summarizing audit findings and any corrective action necessary to mitigate risk
  • Perform data analysis and participate in risk assessment activities that are integral to development of the annual Revenue Integrity coding audit plan
  • Reviews commercial and governmental coding denials and initiates the appeal process, when applicable, working closely with the Revenue Integrity denials management team
  • Reviews coding compliance concerns as related to National Coverage Determinations and Local Coverage Determinations and initiates staff education on such matters as necessary
  • Performs quality assurance and training audits to support coding staff
  • Assigns DRG's proficiently for high case mix index facilities and analyzes documentation for appropriate severity of illness and risk of mortality reporting
  • This is a virtual position with ability to work from previous approved location in the U.S
  • Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis, procedure codes and modifiers

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Professional Skills

  •  Hands on experience with credit risk model...
  •  Other programming/software familiarity: st...
  •  Excellent interpersonal and communications...
5.0
18 votes

Full Stack .NET Developer Resume Sample

Work Experience

  •  Design and development of software applications (primarily web based) used in various areas of the bank (such as Loans processing, Treasury, Middle Office etc.)   •  Unit and Integration Testing – planning, execution and evaluation   •  Production Release preparation and coordinati...
5.0
19 votes

Specialist, BI Resume Sample

Work Experience

  •  Understands logical and physical data models, data modeling methodologies   •  Experience in data reporting and visualization area with atleast 2-3 years’ experience on Tableau development   •  Experience as BI/DW consultant   •  Intelligence, analytical mindset...
Professional Skills

  •  Attention to detail and strong interperson...
  •  Strong skills and experience with scriptin...
  •  Strong project management skills including...
4.7
9 votes
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