Sr. Compliance Auditor, Physician Services

Emory Healthcare•Tucker, GA

About The Position

Reporting to the Director, the Sr. Compliance Auditor, develops and executes audit, monitoring, and education for both facility and professional billing, coding and documentation programs that ensure compliance with regulatory standards across Physician Services. Continuously evaluates facility/professional billing compliance activities to assess compliance with the Compliance Audit and Analysis Program Work Plan and appropriately focuses on risk areas. Serves as a resource for providers and other clinicians on facility/physician billing and coding.

Requirements

Bachelors degree required or experience in lieu of degree (e.g., associates degree and 7 years of experience)
Current Certified Coding Specialist (CCS) or Certified Professional Coder certification required.
Minimum of five years of experience with facility and/or professional audit activities, required.
Proficient in MDAudit Enterprise software and Epic electronic health record systems.
Thorough knowledge of coding documentation improvement practices.
Thorough knowledge and understanding of hospital inpatient billing, coding, and documentation requirements, Federal and State regulations, medical necessity, clinical best practices, and facility/professional billing issues.
Knowledge of legal, regulatory, and policy compliance issues related to coding, billing, procedures, and documentation.
Ability to clearly communicate coding information, including the results of coding compliance audit activities.
Proficiency in root cause analysis, critical thinking, and gaining acceptance of recommended solutions.
Team player and understands role in relationship to others.
Strong interpersonal and communication skills.
Clear, concise, and persuasive writing and presentation skills.
Strong orientation to deadline and detail.
Strong organizational and project management skills.
Working knowledge of computer software Word, Access, Excel, PowerPoint; as well as EMR.
Knowledge of healthcare financial management principles/practices.
Ability to work in highly matrixed environments.
Ability to be flexible and adapt to change.

Nice To Haves

Clinical background preferred (i.e., LPN, RN, etc.)
Certification in Healthcare Compliance preferred.
Project management experience preferred.

Responsibilities

Prepares and oversees facility/professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
Leads focused audits and reviews to investigate adherence with facility/professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
Assists in development of organizational compliance auditing and monitoring activities for facility/professional billing and coding, including periodic reviews of the individual department auditing and monitoring functions.
Coordinates sample reviews to ensure codes that were billed are properly supported by appropriate documentation.
Creates audit result reports to be reviewed with providers and hospital departments.
Organizes and schedules audit findings/education sessions with hospital departments and providers to review audit results.
Conducts trend analyses to identify patterns and variations in facility/professional billing and coding practices that indicate areas of heightened risk.
Serves as primary lead for facility/professional billing compliance education including auditing, trending, and feedback to facility/professional coders and providers working in the hospital and office setting, as applicable.
Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers.
Leads training on proper documentation for facility/professional billing and coding compliance.
Works with the compliance operations, billing team, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.
Evaluates training methods and modalities and works with relevant departments to implement.
Ensures required provider compliance training related to facility/professional documentation, coding and billing is completed on time and in accordance with compliance program policies.
Provides counseling, education and/or recommended disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to facility/professional billing compliance.
Recommends corrective action plans if necessary to address deficiencies identified by auditing and monitoring activities for specific facility/professional services, or on an organization-wide basis.
Conducts audits and manages findings of audits or other reviews in MDAudit Enterprise, and partners with the Manager, Compliance Audit and Analysis, if issues need to be entered into the department's issues tracking modality.
Maintains required credentials, participates in continuing education opportunities to remain current with billing and coding compliance best practices (i.e., conferences, workshops, and other professional development activities).
Maintains confidentiality of patient/members and staff information.
Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.