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Compliance Coding Auditor / Sharp / Compliance & Regulatory / Full time / Day Shift

Job ID JR121290 Date Posted 04/04/2022
San Diego, California
  • Corporate Offices
  • Day
  • Regular
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Shift Start Time:


Shift End Time:


Additional Shift Information:

Weekend Requirements:

Not Specified

On-Call Required:


What You Will Do

The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits.

Required Qualifications

  • 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT.
  • Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) -REQUIRED
  • Certified Professional Coder (CPC) - AAPC -REQUIRED

Preferred Qualifications

  • Bachelor's Degree in Business, Health-Care Administration or related field.
  • Other : Strong background in in ICD-10-CM/PCS coding, DRG coding and CPT coding classification.
  • Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED

Other Qualification Requirements

  • In lieu of degree, a minimum 5 years experience in coding, billing and compliance may be considered.
  • Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire.
    Department management is responsible for tracking and ensuring employee receive certification within specified timeframe.

Essential Functions

  • Compliance Coding and Billing Audits
  • The Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary.
  • Reviews the electronic health record to identify potential coding & billing compliance issues. Prepares written reports of audits, including recommendations to improve compliance.
  • The Auditor will analyze and assess Sharp’s potential risks using SHC’s billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc.
  • Policy and Procedure maintenance
  • Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC’s standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies.
  • Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program.
  • Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education.
  • Unit support
  • Key Stakeholder/Business Unit Support
  • Responsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries.
  • Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding.
  • Maintain professional relationship with key stakeholders focusing on high level of client satisfaction.
  • Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians.
  • Professional competency
  • AHIMA’s Certified Coding Specialist (CCS) or Certified Documentation Improvement Practitioner (CDIP) or AAPC Certified Inpatient Hospital/Facility (CIC) or Certified Professional Coder (CPC) certification is required.
  • Certified in Healthcare Compliance (CHC) is preferred.

Knowledge, Skills, and Abilities

  • Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes.
  • Computer proficiency with Microsoft office applications is required.
  • Ability to function within a fast-paced, dynamic, and growing environment.
  • Excellent time management and problem solving skills.
  • Must demonstrate analytical ability, motivation, initiative, and resourcefulness.
  • Teamwork and flexibility required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Certified Professional Coder (CPC) - AAPC; Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA); Bachelor's Degree; Other; Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate
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