Compliance Auditor II - Ambulatory (Remote)

Position Summary / Career Interest:

• Conduct regular and comprehensive audits to assess the effectiveness and accuracy of internal controls, financial records, and compliance with laws, regulations and the health system's policies and procedures.
• Identify compliance issues, assess risks, and recommend solutions to resolve the issues.
• Analyze and prepare reports on audit findings to include recommendations provided to leadership and providers to enhance the compliance with health system's policies and procedures and mitigate risk.
• Keep updated on new laws and regulations that may affect the health system's operation and its internal policies.
• Routinely audits providers' charges and medical charts to review coding procedures for compliance with government regulations, health system and payor policies and billing accuracy.
• Review and educate HIM coding and billing staff as necessary (i.e. Peer Review, coding and billing rules)
• Demonstrate competence in the areas of critical thinking, interpersonal relationships, and technical skills.
• Prepares clear, concise audit workpapers.
• Mentor providers on billing and coding compliance.
• Follow up with auditees to ensure management responses are received timely and to determine the implementation status of recommendations
• Serves as a resource in addressing compliance queries from Medicare, Medicaid, other third parties, internal legal counsel, Hospital Executive office or other staff/ interested party.
• Serve as a billing guidance resource for HIM professional coding and billing staff.
• Conducts meetings with providers to review findings and recommendations.
• Utilizes audit procedures and other analytical tools to meet objectives determined for completion of special projects.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

• High School Graduate
• 3 or more years medical chart auditing experience
• 5 or more years CPT coding experience in a medical field

• Bachelors Degree

• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)

• Proficient knowledge of medical terminology, ICD-10 and CPT codes
• Knowledge of Medicare and other federal/state compliance guidelines
• Excellent communication skills
• Three years previous medical charts auditing experience
• Coding certification

Time Type:

Job Requisition ID:

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

Need help finding the right job?

We can recommend jobs specifically for you! Create a custom Job Alert by selecting criteria that suit your career interests.