About The Position
The Senior Compliance Auditor ensures the integrity and accuracy of facility and professional compliance audits, monitoring, and provides compliance education for facility and professional documentation, coding, and billing. The Senior Compliance Auditor serves as a mentor for Compliance Auditors and assists management with the onboarding process for new Compliance Auditors. This position requires the use of judgement and critical thinking skills to determine appropriate corrective actions for non-compliance and ensure corrective actions are fully implemented by the entity service line area.
Requirements
- One of the following coding or auditing certifications are required (CCS, CPC, RHIA, RHIT or CPMA).
- Associate's Degree-Related Field of Study (Required)
- Minimum of 7 years-Related work experience (Required)
- Communication
- Critical Thinking
- Medical Billing and Coding
- Organizing
- Problem Solving
- Training and Education
Responsibilities
- Performs scheduled facility and/or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD 10) and billing as required by the Compliance work plan reflecting scheduled activities and target dates.
- Performs audits resulting from unplanned investigations.
- Q/A work products of peers and serve as a mentor for compliance staff.
- Serves as primary lead for facility/professional billing compliance education, including auditing, trending, providing audit feedback to facility/professional coding staff and providers working in the hospital and office setting.
- Coordinates the development and implementation of corrective action and improvement plans with critical attention to performing a root cause analysis.
- Prepares responses to governmental audits, evaluate findings, and manage the appeals process.
- Assess compliance risk areas across Geisinger entities and assist with creating the Compliance Department’s work plan.
- Performs research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
- Provides compliance guidance to Geisinger staff and serve as an institutional resource for Geisinger leadership, management and medical staff with a focus on federal payor billing compliance.
Benefits
- healthcare benefits for full time and part time positions from day one
- vision
- dental
- benefits for domestic partners
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
