Compliance Auditor - CCFMG : Job Details

JOB PURPOSE: The Auditor- Educator is primarily responsible for day to day compliance program activities of monitoring, auditing and education to ensure compliance with requirements for billing and payment. This opposition acts to inform and support organizational compliance efforts in all phases of the revenue cycle. JOB FUNCTIONS Audits and Monitoring Plan and perform, or arrange to perform required compliance audits. Verify accuracy of completeness and compliance with program billing requirements. Compile and track audit results. Provide or arrange to provide for follow-up as required. Analyze audit results. Prepare and deliver timely reports to management. Provide recommendations as indicated, and assist to develop detailed audit response plans. Select and monitor specific revenue cycle controls and outcomes using available tools and reports. Investigate as directed or according to corporate policies and procedures. Prepare required periodic compliance audit reports and other management reports in support of the Compliance Program and plan. Compliance Resource Assist the Compliance Officer with the development, oversight, and monitoring of the Compliance Program, including but not limited to risk assessments, development and maintenance of policies and procedures for compliant documentation, coding, and billing. Maintain an expert level of knowledge with State and Federal Healthcare program rules. Review and provide recommendations in response to regulatory or program changes. Education and Training Assist Revenue Cycle staff to develop and deliver annual and focused coding training and guidance to providers and revenue cycle personnel. Assist with organizational efforts around timely, complete documentation and charge capture. Develop recommendations to improve accuracy and efficiency. Work closely with the revenue cycle teams to design and demonstrate compliant, optimized revenue cycle process, and to address detected areas of non-compliance. Collaboration Consistently demonstrate a professional, collaborative demeanor in support of compliance program and organizational goals. Maintain an expert level of knowledge in the field. Proactively use expertise to inform and assist organizational leaders to evaluate business opportunities or objectives. Requirements JOB QUALIFICATIONS Education: BA/BS in healthcare field. Experience: Minimum five years of applicable healthcare audit experience; Clinical or HIM background desired. Expert user of Encoder, and Electronic Health Records Software. Certifications Licensure: Certified Professional Coder, Auditor certificate preferred. Certified Compliance professional or equivalent PERFORMANCE REQUIREMENTS : Knowledge: Medical audit certification or equivalent knowledge of medical terminology, CPT-4, HCPCS, ICD- 10 coding, modifiers, state and federal billing regulations, health information documentation standards, fee schedule rules, third party coverage and billing requirements. Expert level of knowledge of revenue cycle processes and functions; operation of medical offices, clinics and hospitals; healthcare compliance regulations, and various payment systems. Highly skilled at researching and resolving questions and problems related to the health care revenue cycle. Skills: Strong computer skills and expert use of electronic health record software required. Excellent interpersonal skills. Extensive experience interacting with all manner of personnel (government officials, physicians, leadership and administrative staff); Excellent written and oral communication skills; Strong team player; and demonstrated adherence to strict confidentiality. Strong organizational, analytical and interpersonal skills required. Abilities: Able to plan, analyze, and prioritize workload and meet deadlines and function independently. Equipment Operated: Standard office equipment including computers, scanners, copiers, teleconferencing equipment, etc. Work Environment : Position in a well lighted office environment. Frequent contact with a variety of people. Some local travel and attendance at virtual meetings is required. Eligible to work remotely for certain job-related activities. Physical Requirements: Involves sitting approximately 70-80 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 20 pounds. Safety: All employees are responsible for complying with safe and healthful work practices as outlined in the Company's Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs. Salary Description $68,500 - $94,000 / Year