Compliance Risk Auditor

UIOWA•Iowa City, IA

1d•Hybrid

About The Position

UI Health Care's Joint Office of Compliance is seeking a Compliance Risk Auditor to perform professional and hospital risk audits. This role involves adhering to UI Health Care’s coding/billing and documentation policies and guidelines, as well as federal rules and regulations related to coding and billing activities. The Risk Auditor will be responsible for preparing complex reports, providing education, and escalating trends related to risk audit findings.

Requirements

A Bachelor’s degree in Health Information Management or related field, or an equivalent combination of education and experience.
Certification as RHIT, RHIA, CPC, or equivalent through a nationally recognized credentialing body such as AHIMA or AAPC.
1-3 years coding experience (inpatient, outpatient, professional, hospital or a combination).
Experience working with multiple technology platforms such as an electronic medical record, coding software, and Microsoft Office Suite (Word, Excel, PowerPoint).
Excellent written and verbal communication and interpersonal skills; ability to effectively transmit, receive and interpret ideas, information, and needs through appropriate communication methods and behaviors.
Demonstrated ability to accurately prepare reports and maintain associated electronic records.
Ability to maintain confidentiality.
Demonstrated experience working effectively in a welcoming and respectful workplace environment.

Nice To Haves

Experience with Epic.
Knowledge of hospital and professional billing concepts.
Data collection, analytical skills.
Knowledge of various payer billing requirements as well as billing rules and regulations for Medicare, Medicaid, and other federal payer plans.

Responsibilities

Perform risk audits in accordance with UI Health Care policies and guidelines, federal rules and regulations, and other guidelines governing compliant coding, billing, and documentation.
Adhere to audit scope and perform high level, self-guided research on all required topics (coding/billing rules, federal regulations, internal policy, etc.) necessary to perform audit.
Maintain a high level of understanding and awareness of CPT/HCPCS guidelines and federal coding and billing regulations, compliance program standards, and documentation requirements.
Track and organize findings, communication, resources, and all other items pertaining to audits in shared folders in an accurate and timely manner.
Ensure timely reporting and validation of risk audit findings.
Discuss findings with JOC Risk Audit Supervisor, and other leaders as needed.
Compose detailed summaries of audit findings to be sent via email to providers, clinical department administrators, coders, and other hospital staff in a timely manner.
Communicate and resolve issues and disagreements with coding and providers as they arise during audit.
Conduct audit meetings, in person or virtually, related to findings with providers, coders, and clinical department administrators, requiring a high level of organization and communication for quality delivery of results.
Prepare complex reports to be presented to JOC leadership that detail audit findings which include accurate results, trend identification, organizational impact, and corrective action.
Maintain unit’s SOP documents.