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Mountain Management Services

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.

Sr Coding Compliance Auditor

Location

Northern America + 9 moreAll locations: Northern America | Americas | Latin America (LATAM) | Europe | EMEA | Asia | Africa | Asia Pacific | Eastern Europe | DACH

Posted

45 days ago

Salary

$25 - $38 / hour

Seniority

Senior

No structured requirement data.

Job Description

Sr Coding Compliance Auditor

Mountain Management Services

Role Description As our Auditor, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility. Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making. To be successful, you’ll combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements. - Performs prospective and concurrent chart reviews to ensure documentation is complete and compliant to facilitate the accurate reporting of HCC diagnoses via claims. - 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. Qualifications - Five years physician coding experience. - Certified Rehabilitation Counselor, within 12 months. - Certified Professional Coder Hospital Apprentice, upon hire. - Certified Professional Coder Apprentice, upon hire. - Certified Coding Associate, upon hire. - Cardiology Coding, upon hire. - Certified Coding Specialist, upon hire. - Certified Coding Specialist - Physician Based, upon hire. - Certified Cardiovascular and Thoracic Surgery Coder, upon hire. - Certified Health Care Compliance, upon hire. - Certified Interventional Radiology Cardio Coder, upon hire. - Certified Professional Coder, upon hire. - Certified Professional Coder Hospital, upon hire. - Radiology Certified Coder, upon hire. - Registered Health Information Administrator, upon hire. - Registered Health Information Technician, upon hire. Requirements - Associates Other, upon hire. - Three years experience performing diagnosis, E/M, and procedure code audit/review/education functions for professional fees in multi-specialty setting. - Registered Nurse: TN, upon hire. - Licensed Practical Nurse: TN, upon hire. - Certified Nursing Assistant: TN, upon hire. - Certified Professional Medical Auditor, upon hire.

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