Compliance Audit Specialist

Mosaic Health • New York, NY

2d

About The Position

The Compliance Audit Specialist is responsible for participating in due diligence audits for new acquisition and new providers. The Compliance Audit Specialist is responsible for completing ad-hoc audits as required by the business on different coding and documentation issues. • Reviews audit results received from the outside vendor, analyzes data, and composes rebuttals based on CMS guidelines, and payors policies and procedures. • Hosts education sessions for providers after reviewing data on the new provider audit and routine audit. • The Compliance Audit Specialist is responsible for researching payors updates, policies and procedures and communicating these updates timely with providers and Mosaic appropriate teams. • Responds to questions from providers and other Mosaic teams. • Participates in team meetings and organizational business meetings. • Responds to questions in Athena from providers and peers regarding coding and documentation issues. • Supports the team with any required audits and responds timely to communication. • The Compliance Audit Specialist is responsible for the day-to-day operations of the Compliance Audit and Education program. It is expected the Compliance Audit Specialist will accurately follow all applicable federal, state, and local guidelines for the processing of patient information, applying coding rules, and providing coding guidance. Acts as a subject matter expert and a resource for healthcare providers and internal teams. • Maintains productivity standards of a minimum of 25-30 charts per day based on the complexity of the documentation, and elements reviewed. • Coordinates work with Compliance Leadership to ensure consistent, efficient, and effective functions of the program.

Requirements

• A minimum of 3 years related physician coding/billing experience and/or training; or equivalent combination of education and experience
• Must hold a current AAPC Certified Professional Coder certification and/or AHIMA Credentials CCS-P (Certified Coding Specialist – Physician)
• Experience with E/M, HCC coding review
• Coding certifications required
• Experience with E/M, HCC coding reviews
• Clear, concise, and professional communication to different audience dependent on the project and its goals
• Time management, meetings, and deadlines may require hours outside standard 40-hour work week
• Position requires flexibility in work hours, multi-tasking, and excellent computer skills

Nice To Haves

• Certified Professional Medical Auditor (CPMA) a plus
• Any additional coding certification a plus
• A bachelor’s degree is preferred but not required
• Any additional coding certification a plus

Responsibilities

• Participating in due diligence audits for new acquisition and new providers
• Completing ad-hoc audits as required by the business on different coding and documentation issues
• Reviews audit results received from the outside vendor, analyzes data, and composes rebuttals based on CMS guidelines, and payors policies and procedures
• Hosts education sessions for providers after reviewing data on the new provider audit and routine audit
• Researching payors updates, policies and procedures and communicating these updates timely with providers and Mosaic appropriate teams
• Responding to questions from providers and other Mosaic teams
• Participating in team meetings and organizational business meetings
• Responding to questions in Athena from providers and peers regarding coding and documentation issues
• Supporting the team with any required audits and responds timely to communication
• Responsible for the day-to-day operations of the Compliance Audit and Education program
• Accurately follow all applicable federal, state, and local guidelines for the processing of patient information, applying coding rules, and providing coding guidance
• Acts as a subject matter expert and a resource for healthcare providers and internal teams
• Maintains productivity standards of a minimum of 25-30 charts per day based on the complexity of the documentation, and elements reviewed
• Coordinates work with Compliance Leadership to ensure consistent, efficient, and effective functions of the program
• Support the Compliance program by providing timely audit reports and statistics to the Annual Risk Assessment and investigation, audit reports
• Partner with Director of Compliance to elevate higher visibility and understanding of top risks and building a culture where open and transparent risk decisions are made across the organization
• Support policy updates, renewals, coding advisory opinions to provide new policy snippets or specific training sessions for providers
• Develop the design and delivery methods of role-based education and training, support the creation of new delivery methods for both clinical and non-clinical staff; develop communication and training campaigns, engaging with clinical teams at huddles & monthly meetings, and assist in establishing evaluation metrics for training
• Oversee and perform auditing and monitoring to ensure that the organization follows regulatory and legal requirements; collaborate with Peer Compliance Audit specialists and external audit vendors in developing focused education and training for target areas of improvement
• Ensure that the functionality and data elements of reports are accurate
• Coordinate with the Director of Compliance Audit to ensure organizational, program, and individual benchmarks are met
• Oversees the continuous evaluations of the quality of clinical documentation to identify incomplete or inconsistent documents for inpatient and/or outpatient encounters that impact the code selection and resulting APC/DRG groups and payment; brings concerns to the attention of peer Compliance Audit Specialists, and the Director of Compliance
• Supports Corrective Action Plans through collaborating with staff, providers, compliance team, quality, IS/IT, and HR
• Improve effectiveness and efficiencies to meet increased oversight on corrective actions
• Facilitate audit resolution, identify accountability, and agreements for timelines results delivery
• Maintains knowledge of current and required coding certifications as appropriate; may perform the most technical complex and difficult coding and abstraction work
• Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association/AAPC, reports areas of concern to the Compliance Officer
• Assist Compliance Leadership, serving as a program representative by attending coding and reimbursement workshops and bringing back information as appropriate; communicates any updates published in third-party payer newsletters, bulletins and/or provider manuals; shares information with facility staff as directed
• Stay informed about transaction code sets, Health Insurance Portability and Accountability Act (HIPAA) requirements and other future issues impacting health information management functions; keeps abreast of new technology in coding and abstracting software and other forms of automation
• Demonstrate and maintain expertise in the use of computer applications
• Monitor and audit unbilled account reports, hold lists etc.; for claims awaiting coder review and facilitates the delegation of work to reduce accounts receivable days for these claims
• In partnership with appropriate personnel, recommend opportunities for standardized, organization-wide coding guidelines and documentation requirements (Coding Alerts)
• Project manage multiple initiatives with ability to prioritize and meet deadlines
• Demonstrate excellent communication skills to internal team members and patients
• Perform other related duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level