Compliance Coding Auditor , ATM

Advanced Medical Management•Long Beach, CA

54d

About The Position

As a member of AMM’s Compliance and Ethics team, the Compliance Coding Auditor is an important driver of our mission. They are responsible for supporting the Company’s Compliance & Ethics Program (the Program) auditing, tracking, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM’s key stakeholders, including patients and their families and government agencies, and AMM is committed to exceeding those expectations. The Program is led by AMM’s CCEO, who reports to AMM’s Chief Executive Officer and the AMM Board, and who oversees and manages the AMM Compliance Committee, consistent with industry best practices. The Compliance Coding Auditor for the Auditing, Tracking, and Monitoring team is expected to exemplify the Company’s culture and core values. This is a role that requires sound and risk-aware judgment, productive collaboration across the Company, and demonstrated success in performing audits to determine organizational integrity of billing and risk adjustment metrics, including: appropriate documentation, accurate coding and billing, and/or medical necessity of services billed.

Requirements

Required five to ten years of relevant professional experience in healthcare, including coding and/or auditing roles. Experience auditing healthcare claims in a professional services firm and/or in-house at a large healthcare provider organization, health system, and/or payer.
An undergraduate degree; preference for Health Business or related field.
In lieu of an undergraduate degree, HS Diploma/GED and five (5) additional years of relevant experience will be considered
Required coding certification, preferred Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC), from the American Academy of Professional Coders (AAPC)
Required top-tier healthcare audit certification, preferred Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders (AAPC) along with a fundamental understanding of regulatory framework and coding practices.
Fundamental understanding of government healthcare programs (i.e., Medicare and Medicaid).
Demonstrated ability to work effectively with key internal and external stakeholders.
A demonstrated ability to cultivate working relationships with representatives from government agencies.
An ability to operate successfully in a flat culture, with the courage and competence to engage on multiple fronts and tackle challenges head-on.
An ability to prioritize effectively, and exercise sound judgment, in a fast-paced, physician-driven environment.
A demonstrated ability to accurately apply the necessary methodologies, professional standards, and government agency expectations for conducting healthcare auditing, testing, and monitoring activities.
Exemplary integrity with courage and an unwavering ethical compass.
Pragmatic, risk-aware professional judgment.
Demonstrated tact, trustworthiness, and diplomacy skills needed to manage sensitive and confidential information such as protected health information.
An adept listener with a sense of humility.
Capable of earning the respect and confidence of colleagues through demonstrated professional excellence and expertise.
Prompt and efficient ability to manage shifting priorities, demands and timelines.
Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.

Responsibilities

Ensures that the Manager is timely informed of all key findings of internal compliance tests and assessments, audits, and monitoring initiatives.
Undertakes to remain informed of relevant developments and trends in healthcare compliance and ethics by, among other things, attending seminars, reviewing professional journals, and actively participating in professional organizations, and leverages that insight and knowledge to enhance the Program.
Performs internal compliance department audits based on departmental planning to determine accuracy and adequacy of documentation and coding related to physician billed services based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
Prepares written reports of audit findings, with recommendations, and presents to the Manager for review and presentation to appropriate stakeholders; maintains audit records.
Performs focused audits as needed in response to reported compliance and ethics concerns, with direction from the Manager of Auditing, Testing, and Monitoring.
Ensures that written evaluative reports of findings are developed for all initiatives undertaken.
In collaboration with the appropriate business unit leader, supports corrective action plans to address systemic issues or pervasive practices that could give rise to potential violations of applicable laws, regulations, or AMM’s Code of Conduct and/or policies and procedures.
Other duties as assigned

Benefits

Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
Career Development: Tuition reimbursement to support your education and growth.
Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!

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