Sr. Revenue Cycle Compliance Auditor

Adventist Health • Roseville, CA

292d

About The Position

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions through an action plan. Responsible for coordinating, developing, and conducting educational training based on audit outcomes. Provides educational training to coders, billers, physicians, and others on documentation requirements and correct coding of inpatient, outpatient, and professional fee services. Applies substantial knowledge of the job and experience to complete a wide range of activities with varying difficulty. Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program.

Requirements

• Associate's/Technical Degree or equivalent combination of education/related experience: Required.
• Bachelor's Degree: Preferred.
• Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services: Required.
• Five years' experience in auditing in clinic and/or facility revenue cycle: Preferred.
• Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-Phy) or Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT): Required.
• Professional Medical Auditor (CPMA) or Certified E&M Coder (CEMC) or Certified E&M Auditor (CEMA) or Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist- (CCDS) or CIRCC-AAPC or Radiation Oncology Certified Coder (ROCC): Preferred.

Responsibilities

• Perform comprehensive reviews of health care records for accuracy of revenue cycle billing compliance.
• Conduct internal audits and coordinate external audits including Recovery Auditor Contractors' (RAC), Livanta, Target Probe and Educate (TPE) and Attorney Client Privilege Audits.
• Produce comprehensive audit finding reports that include quantifiable impact and improvement recommendations.
• Ensure timely dissemination of external audits and generate timely appeals.
• Communicate opportunities regarding proper clinical documentation guidelines and coding principles.
• Lead and facilitate multi-disciplinary workgroups or projects.
• Mentor, coach, and provide on-job training for staff.
• Participate in improving the efficient and effective delivery of the Department's services.
• Generate audits utilizing Auditing platform for denials and coding reviews.
• Review and research state and federal regulations and complex documents.
• Participate in annual risk assessment and work plan development processes.

Benefits

• Adventist Health is committed to the safety and wellbeing of our associates and patients.
• Medical and religious exemptions may apply.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree