Staff Coding Compliance Auditor (medical billing and coding)

Geisinger • PA

68d

About The Position

The Compliance Auditor position is responsible for supporting the organization’s Revenue Management Compliance department in developing, implementing, and administering an effective compliance program. Accurately audits and provides compliance research support to physicians, non-physician practitioners, leadership, and administrative staff on documentation and coding requirements. Determines the adequacy of medical record documentation, coding, and billing, using established compliance auditing and research guidelines for hospital and professional services.

Requirements

• Minimum one Coding Certification required: Certified Professional Coder - AAPC, Certified Risk Adjustment Coder - AAPC, Registered Health Information Technician (RHIT) - American Health Information Management Association.
• High School Diploma or Equivalent (GED) required.
• Minimum of 6 years relevant experience required.
• Skills: Computer Literacy, Multitasking, Organizing, Teamwork.

Responsibilities

• Performs compliance audits to determine the adequacy of medical record documentation, billing, and coding, utilizing policies, procedures, Federal and State laws, regulations, and standard coding guidelines.
• Evaluates whether documentation and coding patterns present a compliance risk to the organization and provides input on recommended solutions.
• Identifies training and education needs through compliance audit results prepared and partners with peers to educate physicians and non-physician practitioners, as determined appropriate.
• Serves as a clinical coding subject matter expert for multiple assigned specialties and utilizes critical thinking when evaluating matters potentially impacting compliance.
• Maintains an expert level of knowledge with State and Federal healthcare program regulations.
• Works closely with revenue cycle staff to review systems and/or workflows established to ensure compliance with policies, plans, procedures, laws, and regulations.
• Reviews service line operations or programs to ascertain whether audit results are consistent with established policies, procedures, Federal and State regulations.
• Identifies and defines audit scope and criteria and program of examination for the assigned areas being audited.
• Responsible for surveying the functions and activities in the assigned areas being audited to determine the nature of operations and adequacy of the system to achieve established objectives.
• Identifies key control points of assigned areas being audited.
• Obtains, analyzes, and appraises evidentiary data and available information as a basis for making an informed, objective opinion on the adequacy and effectiveness of systems and the performance of assigned areas being audited.
• Makes recommendations for improvement and corrective action plans where appropriate.
• Prepares accurate executive briefs showing the results of assigned areas being audited in accordance with those practices followed within the general scope of the audit parameters.
• Appraises the adequacy of corrective action taken by management to address findings identified through an external audit engagement.
• Provides input in the risk assessment process to determine specific areas of focus for compliance risk mitigation as directed by Compliance or Senior Leadership.

Benefits

• Healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.
• Encouragement of an atmosphere of collaboration, cooperation and collegiality.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees