I have extensive experience with medical coding and auditing, having worked with ICD-10, CPT, and HCPCS codes. In my previous role, I conducted audits to ensure compliance with coding guidelines and regulations, identifying discrepancies and recommending corrective actions. This involved reviewing patient records, verifying diagnoses and procedures, and ensuring accurate reimbursement. My background in nursing combined with my coding expertise allows me to effectively bridge clinical practice with administrative requirements.

When identifying discrepancies in patient records, I first conduct a thorough review to understand the nature of the issue. I then collaborate with the clinical team to gather additional information if needed. My approach involves using evidence-based practices to validate the accuracy of the records and ensure they meet regulatory standards. Once discrepancies are identified, I work with the team to implement corrective actions and update the records accordingly. My goal is to maintain the integrity of the patient data while ensuring compliance with all relevant guidelines.

To ensure compliance with healthcare regulations, I stay updated on the latest guidelines and standards, such as those from CMS and HIPAA. I conduct regular audits to identify any potential non-compliance issues and provide training to the staff on regulatory requirements. Additionally, I implement policies and procedures that align with these regulations and monitor their effectiveness through ongoing audits. By fostering a culture of compliance and continuous improvement, I help ensure that our practices meet all necessary standards.

When I discover significant errors in patient billing, I first document the issue thoroughly and assess its impact on the patient and the organization. I then communicate the findings to the relevant departments, such as billing or clinical services, to initiate corrective actions. Depending on the severity, I may also involve higher management or legal counsel. My priority is to rectify the error promptly and prevent future occurrences by reviewing and improving our billing processes. Transparency and patient satisfaction are key in these situations.

In a previous role, I noticed that our auditing process was time-consuming and prone to errors. To improve efficiency, I introduced a standardized checklist and automated some of the data collection steps using software tools. I also trained the team on best practices for auditing and provided regular feedback on their performance. As a result, we reduced the time spent on audits by 30% and significantly improved the accuracy of our findings. This not only enhanced our compliance efforts but also freed up resources for other critical tasks.