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Compliance Auditor

Remote: 
Full Remote
Contract: 
Full time
Work from: 
India

Offer summary

Qualifications:

Bachelor's degree in accounting, business administration, or healthcare related field required., AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist-Physician-based (CCS-P) certification required., Strong understanding of healthcare regulations such as HIPAA, Medicare, and Medicaid is essential., Minimum of 5 years experience in healthcare compliance and auditing..

Key responsabilities:

  • Plan and conduct audits of clinical and administrative processes, including coding and billing compliance.
  • Prepare and submit written audit reports with findings and recommendations to the Director.
  • Ensure corrective action plans are developed, implemented, and effective following audits.
  • Stay updated on regulatory changes and maintain knowledge of medical documentation and coding requirements.

Yitro Global logo
Yitro Global
51 - 200 Employees
See all jobs

Job description

JOB TITLE:
Compliance Auditor
NUMBER OF OPENINGS:
Two
JOB SUMMARY:
The Compliance Auditor is responsible for planning and conducting audits of company's clinical and administrative processes, including coding and billing.
compliance, documentation, medical necessity, adherence to internal policies, procedures and
guidelines, services provided by outside vendors including company's revenue cycle vendor, and
compliance with state and federal regulations including HIPAA Privacy and Security. The
Compliance Auditor is responsible for preparing and submitting written audit reports that include
findings and recommendations, communicating findings to the Director, developing and
implementing corrective action plans when necessary, and following up to ensure that corrective
plans are implemented and were effective.
JOB RESPONSIBILITIES:
Implement the Audit Process
Plan and schedule audits, including identifying the audit subject and purpose, defining audit
objective(s), defining audit scope, performing pre-audit planning, and notification to the
area(s) to be audited.
Conduct audits, including meeting with impacted employees and keeping impacted
organizational areas(s) apprised along the way of any findings and urgent actions to be taken
if necessary.
Develop audit reports that includes findings, recommendations designed to correct any
potential weaknesses or areas of noncompliance discovered during the audit, request for
management response to each finding or recommendation including corrective action plan(s)
to be developed and implemented.
Provide follow-up prior to closing the audit including confirming successful implementation
of corrective action plans, verify that management responses are implemented, and assess
new processes, procedures and actions.
Stay Abreast of Applicable Regulatory Changes
Maintain current knowledge of medical documentation, fraud, abuse, and documentation and
coding violations based on governmental guidelines, including State and Federal
overpayment regulations.
Stay abreast of and maintain current knowledge of Medicare and Medicaid guidelines.
applicable to company's Pain Management Clinics and Ambulatory Surgical Centers (ASCs),
including applicable Local Coverage Determinations (LCDs).
Maintain current knowledge of requirements and guidance required in the performance of
audit duties, including but not limited to ICD-10, HCPCS, and CPT coding, modifiers, and
surgical procedures documentation requirements.
Maintain current knowledge of HIPAA Privacy and Security Requirements.
Conduct Audits
Review medical records to determine the medical necessity of services billed and the
accuracy of coding, billing, and supporting clinical documentation in either an Ambulatory
Surgical Center (ASC) or a Pain Management Clinic.
Review records that have been reviewed and coded by the revenue cycle vendor.
Review company's practices, procedures, and materials for compliance with CMS and HIPAA
regulations.
Prepare audit reports of findings and observations that identify, in detail, areas of non-
compliance and risk areas for non-compliance.
Ensure corrective actions are implemented and effective.
Conduct other audits as assigned, including but not limited to contract reviews, lease
agreements, compliance with contract language, etc.
Share departmental responsibilities as assigned.
JOB REQUIREMENTS:
Bachelor s degree in accounting, business administration, or healthcare related field required.
AAPC Certified Professional Coder (CPC ) or AHIMA Certified Coding Specialist-
Physician-based (CCS-P) certification, required.
Certified Professional Medical Auditor (CPMA) certification preferred.
Healthcare compliance certification, a plus.
A strong understanding of healthcare regulations, such as HIPAA, Medicare, Medicaid, and
other relevant industry standards, is essential.
Solid grasp of auditing principles, techniques, and methodologies.
Experience working autonomously.
Healthcare auditing, billing/coding experience, required.
A minimum of 5 years experience in a healthcare compliance.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of federal (including HIPAA) and state regulatory requirements.
Strong analytical and critical thinking skills.
Attention to detail and the ability to think strategically.
Excellent written and verbal communication skills to present findings and results effectively.
Ability to work well in a team, contribute effectively, and manage priorities.
Good computer software skills and knowledge.
Knowledge of data analysis and audit software tools is a plus.
HOURS AND WORKING CONDITIONS:
Work from Office, Timings- 1pm -10 pm
Our corporate office is located in Tampa, FL. This job may require travel to company's locations.
throughout Florida, Texas, and California.
Please note this job description is not designed to cover or contain a comprehensive listing of activities,
duties or responsibilities that are required of the employee for this job. Duties, responsibilities and
activities may change at any time with or without notice.
__________________________________________________________________________
Employee s Printed name Date
___________________________________________________________________________
Employee s Signature Date

Required profile

Experience

Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Time Management
  • Teamwork
  • Problem Solving
Are you interested?

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