Position Code
Not Specified
Education Required
Associates degree
Type of Position

Compliance Audit Coordinator

Job Description:

JOB SUMMARY Responsible for managing medical record requests for additional documentation (ADR) to avoid technical denials. The Compliance Audit Coordinator (CAC) will track and coordinate responses for all denial letters from government audit contractors including but not limited to Recovery Audit Con-tractor (RAC), Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Medicaid Integrity Contractor (MIC), and Zone Program Integrity Contractor (ZPIC) as well as 3rd party challenges for DRG and Medical Necessity. Reports revenue at risk, recouped and re-covered activities to the Resource Management Committee and serves on the Revenue Cycle Sub-committee, Health Information Services (HIS)/Central Business Office (CBO) bimonthly meeting. Assists the Coding Manager with education, coding compliance audits and periodic coding to meet the overall needs of the coding team. Provides status updates to Director as requested.

Job Requirements:

QUALIFICATIONS 1. RHIA/RHIT active status required with advanced certification preferred. 2. Minimum 3 years experience in coding preferred. 3. One-year experience with RAC and/or other Revenue Integrity functions strongly desired. 4. Strong understanding of appeals processes for government contractors. 5. Understanding of Case Management principles essential. 6. Knowledge of medical record documentation practices required. 7. Knowledge of medical/hospital charge processes beneficial. PHYSICAL REQUIREMENTS 1. Able to communicate clearly and distinctly with staff, physicians, and other hospital employees. 2. Able to sit/stand/walk for extended periods of time throughout the work schedule with some lifting and bending. 3. Demonstrates adequate vision for reading current literature and preparing written documents. Must be able to distinguish colors. 4. Able to extensively utilize telephone, email and written communication. 5. Demonstrates adequate stamina to deal with stressful situations and complete work schedule. 6. Fine motor skills and hand-eye coordination to operate business office machines. 7. On-site position. JOB RELATIONSHIPS 1. Report to Coding Supervisor. 2. Work effectively with all hospital employees, physicians, and other office personnel demonstrating team approach. 3. Contributes a positive attitude and department cohesiveness by working cooperatively with other staff members. 4. Strong customer service orientation. 5. Must be able to communicate effectively using verbal and written communication.