Grady Health System - Atlanta, GA
posted 6 days ago
The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director, Compliance Director. This position requires effective communication with internal stakeholders and external auditors. Candidate should possess excellent organization skills to ensure accuracy and timeliness of audit results. Assess the educational needs of physicians regarding coding and documentation and direct development of effective regularly scheduled educational programs that meet physician needs and serve as the primary resource to physicians for documentation and coding issues. Responsible for conducting coding and billing training programs for billing and coding specialists and physicians. Creates presentations, develops learning material, handbook and other training materials. Conducts coding and data quality reviews and prepares complex reports as required. Ensures all Revenue Cycle coding activities comply with clinical billing standards and government regulation with concentration on hospital inpatient procedures and specialty physician services.