Position Summary

The Compliance Specialist I audits medical record documentation to identify under-coded and up-coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues. Interacts with providers and management to review and/or implement codes and to update charge documents. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.

Major Duties and Responsibilities

• 
  Responsible for auditing medical records documentation.
• Responsible for running reports needed to research and analyze data.
• Access records from Electronic Health Records (EHR) system.
• Ensure coding is in compliance with current Medicare guidelines with Current Procedural Terminology (CPT) and diagnosis codes.
• Ensure the integrity and accuracy of the documentation in the clinical record, public speaking, report findings and one-on-one communication with physicians, clinical and office staff.
• Other duties as assigned.

Knowledge, Skills and Abilities

• 
  Knowledge of ICD-10 coding.
• Knowledge of computer systems (e.g., Excel, Word and PowerPoint).
• Ability to work scheduled hours as defined in the job offer.
• Ability to read and understand oral and written instructions and follow written protocols.
• Ability to examine documents for accuracy and completeness.
• Ability to use office equipment (e.g., calculator, copier, fax, etc.).
• Ability to provide excellent customer service.
• Skill in presenting information in an organized manner.
• Skill in verbal and written communication.

Education / Training / Requirements

• 
  Associates Degree or equivalent.
• Up to 5 years related experience.
• CPC, COC OR RHIT certification.

Physical Demands

• 
  Ability to lift or move equipment.

• Ability to stand and walk for limited periods of time.
• Ability to sit for extended periods of time.
• Ability to enter data into a computer via a keyboard.
• Ability to occasionally reach, bend, stoop and lift up to 30 lbs. *
• Ability to grasp and hold up to 30 lbs.*
• Ability to occasionally squat and lean over.
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Ability to see and understand data on a computer screen.

Success Factors

• 
  Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail
• Accomplished in word processing and worksheet utilization

All statements are essential functions of the position unless identified as non-essential by an asterisk (*).