Position Title

Compliance Auditor II - Ambulatory (Remote)

Delp Pavilion

Position Summary / Career Interest:Works with Ambulatory Services Compliance Director and Compliance Audit Manager to develop, provide and communicate recommendations and education to department leadership and providers as determined by audit findings. Assists Director of Ambulatory Compliance Services in preforming federal and state regulatory research, making presentations to internal and external audiences, and providing education to departments on federal and state compliance guidelines.

Responsibilities and Essential Job FunctionsConduct regular and comprehensive audits to assess the effectiveness and accuracy of internal controls, financial records, and compliance with laws, regulations and the health system's policies and procedures. Identify compliance issues, assess risks, and recommend solutions to resolve the issues. Analyze and prepare reports on audit findings to include recommendations provided to leadership and providers to enhance the compliance with health system's policies and procedures and mitigate risk. Keep updated on new laws and regulations that may affect the health system's operation and its internal policies. Routinely audits providers' charges and medical charts to review coding procedures for compliance with government regulations, health system and payor policies and billing accuracy. Review and educate HIM coding and billing staff as necessary (i.e. Peer Review, coding and billing rules) Demonstrate competence in the areas of critical thinking, interpersonal relationships, and technical skills. Prepares clear, concise audit workpapers. Mentor providers on billing and coding compliance. Follow up with auditees to ensure management responses are received timely and to determine the implementation status of recommendations Serves as a resource in addressing compliance queries from Medicare, Medicaid, other third parties, internal legal counsel, Hospital Executive office or other staff/ interested party. Serve as a billing guidance resource for HIM professional coding and billing staff. Conducts meetings with providers to review findings and recommendations. Utilizes audit procedures and other analytical tools to meet objectives determined for completion of special projects. Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department. These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.
Required Education and ExperienceHigh School Graduate 3 or more years medical chart auditing experience 5 or more years CPT coding experience in a medical field
Preferred Education and ExperienceBachelors Degree
Required Licensure and CertificationCertified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)
Knowledge RequirementsProficient knowledge of medical terminology, ICD-10 and CPT codes Knowledge of Medicare and other federal/state compliance guidelines Excellent communication skills Three years previous medical charts auditing experience Coding certification

Time Type:Full time

Job Requisition ID:R-40947

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

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