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Auditing and Coding Compliance Specialist in Philadelphia, PA at Resources For Human Development, Inc.

Date Posted: 2/4/2019

Job Snapshot

Job Description

Position Summary

Upholds the mission and beliefs of the organization by working with the Director of Finance to ensure correct and compliant coding based on provider documentation in order to assure appropriate billing and to maximize revenue. Strive to maintain best practices in order to achieve high quality, person centered care.

Essential Duties and Functions


Ensures the daily claim edits are corrected within 24 hours of receipt in queue.

Reviews billing of all disciplines for appropriate CPT codes to visits on a regular basis

Reviews billing for appropriate ICD-10 diagnostic codes to visits

Makes necessary changes to codes to ensure timely billing.

Conducts in-house provider coding audits at least quarterly for PC, Family Planning Prenatal, and Behavioral Health and at least bi-annually for Dental, Podiatry and other specialty services.

Documents the in-house audit review process and associated audit findings on a detailed level to present to Director of Financial Operations. Summarizes data in accordance to Director of Finance Operations direction for presentation to quarterly CQI Committee.

Acts as a liaison to any outside chart reviewers and coordinates outside chart audit activity.

Reviews outside audit reports. Creates and implements a Plan of Action based on audit findings and recommendations related to coding/documentation issues.

Consults with CRNP's and other clinical staff to clarify documentation and interpret clinical information necessary to effectively code all visits

Act as a coding resource to clinical staff

Conducts coding and related documentation training for both clinical and billing staff as needed

Maintain competency and awareness of all coding changes that affect services provided throughout the organization

Monitors all payor updates for coding updates, additions, changes, deletions.

Participates in staff meetings and attends other meetings and seminars as requested.

Follows up with clinical staff to ensure audit findings are corrected and meet CMS, Federal, State or other regulatory compliance standards.

Keeps up-to-date on coding knowledge and practices

Works with IT staff to ensure that the various practice management systems (Centricity and Dentrix) are kept up to date with current coding and documentation needs.


Maintains communication with provider representatives and outside agencies regarding concerns and insurance changes specific to coding and billing

Open communication with operation managers regarding coding policies and procedures

Regular communication/updates with Director of Financial Operations as related to coding compliance and audit findings

Ability to work professionally and collaboratively with department heads and clinical staff


Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) REQUIRED

Previous experience with EMR and Practice Management Software required

Bachelor's or Associate's Degree in Health Sciences- related field or equivalent experience preferred

Minimum 3 years coding experience

Knowledge of Government Reimbursement (Medicare and Medicaid)

Able to meet strict deadlines and prioritize work effectively

Ability to be detailed oriented and perform tasks at a high level of accuracy