Compliance Auditor - MPG - FT - Days - MHS

Memorial Healthcare

5d

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.

Requirements

• Associates (Required)
• Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC)
• Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead.
• Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
• Associate's degree in Health Information Management, Health Information Technology, Health Informatics, or related field.
• Certified Coding Associate (CCA from AHIMA) or CPC - Certified Professional Coder – American Academy of Professional Coders (AAPC) or HCC - Hierarchical Condition Category – American Academy of Professional Coders (AAPC) or CRC - Certified Risk Adjustment Coder – American Academy of Professional Coders (AAPC) or CPMA - Certified Professional Medical Auditor – American Academy of Professional Coders (AAPC).

Nice To Haves

• Bachelor’s Degree preferred.

Responsibilities

• Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.
• Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.
• Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.
• Follow up on audit findings to ensure that the corrective action plans are effective.
• Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.
• Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.
• Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.
• Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.
• Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree