JOB TITLE:	Coding and Compliance Analyst
REPORTS TO:	Business Office Manager
FLSA STATUS:	Non-exempt
JOB OVERVIEW:	Support and provide coding and compliance training to physicians, clinical personnel and billing staff, establish effective communications with physicians and clinical staff on coding issues and provide auditing services to ensure accurate and ethical coding of claims.

ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

1. Audit physician medical records and charges to ensure compliance with coding standards.
2. Educate physicians and clinical staff to appropriate documentation as required by medical
review.
3. Development and documentation of an effective auditing and compliance program including
standards of conduct with respect to ethical billing practices.
4. Development and application of written policies promoting the Clinic’s commitment to
compliance and addressing specific areas of potential fraud.
5. Conduct periodic meetings with providers to include:
a. Chart reviews
b. Coding reviews for over/under coding patterns
c. Coding patterns in general and in specific
d. Revenue enhancement opportunities
e. Billing and insurance department workflow including re-billings and payments.
6. Address over coding and/or under coding issues individually with physicians and other providers.
7. Work closely with PAR IV’s to do new physician audits including documentation review during
first month and audit of charges to ensure coding accuracy during month 3.

ADDITIONAL RESPONSIBILITIES:

1. Participate in special audits as instructed.
2. Work as a team member within the business office and all other departments.
3. Document work processes as required.
4. Perform other duties as assigned.

QUALIFICATIONS:

Education:
High school diploma or equivalent.

Certification/Licensure:
CPC certification required.

Experience:
Minimum 3 years healthcare training and medical service coding experience.

Skills:
1. Medical terminology.
2. Ten-key and keyboarding skills.
3. Strong organizational and interpersonal skills including the ability to deliver difficult information
positively.
4. PC applications including Excel and Word.
5. Knowledge of RBRVS and insurance (i.e. Medicare, L&I, DSHS) reimbursement regulations.
6. Ability to establish rapport and trust in dealing with physicians and staff regarding coding issues.

Other Requirements:
1. Ability to prioritize responsibilities.
2. Ability to multi-task efficiently and effectively.
3. Must be able to act calmly and effectively in a busy or stressful situation.
4. Ability to communicate effectively in the English language in person, by phone and in writing.
5. Knowledge of contracted insurance plans and procedures.
6. Requires adherence to all policies and procedures, including standards for safety, attendance,
punctuality and personal appearance.
7. Must be able to establish and maintain effective working relationships with managers and peers.

Physicial Requirements:
Hearing: Adequate to perform job duties in person and over the telephone.
Speaking: Must be able to communicate clearly to physicians and staff in person and over the
telephone.
Vision: Visual acuity adequate to perform job duties, including reading information from printed
sources and computer screens.
Other: Requires frequent bending, reaching, repetitive hand movements, standing, walking,
squatting and sitting, with some lifting, pushing and pulling exerted regularly throughout a
regular work shift.

THE DOCTORS CLINIC IS AN EQUAL OPPORTUNITY EMPLOYER

Last update: 9/19/2001

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