Sr Coding Compliance Auditor

Where You’ll Work

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Job Summary and Responsibilities

As a Sr Coding Compliance Audito,r is responsible for reviewing chart notes for proper coding with an emphasis on documentation, coding improvement, and revenue capture.

Every day you will provide education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings, webinars, and online modules.

To be successful in this role, you will develop, maintain and present coding and compliance educational materials to staff and clinicians. Collaborate with the coding team to support the needs of the organization.

The position will support risk adjustment improvement efforts across the medical group.

• Works to resolve claims denials and reports denial trends to leadership 
• Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patients' chart note. 
• Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures. 
• Partners with the quality team, clinically integrated network and payers as necessary, to identify trends and gaps for creating a better process. 
• Assists in the development and reporting of HCC and Pay for Performance metrics. 
• Adheres to deadlines and ensures reports are completed and distributed to all concerned parties. 

Job Requirements

Required

• Coding Certification through American Health Information Management Association (AHIMA) as Certified Coding Specialist (CCS) or
• Certified Coding Specialist Physician Based (CCS-P) or
• The American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) required

Preferred

• Professional Medical Auditor Certification (CPMA) (CMAS)-preferred
• CRC Certification preferred or must be obtained within the first year