Coding & Documentation Compliance Auditor

Hartford HealthCare; Hartford (CT); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Competitive benefits program

Career development opportunities

Work/life balance initiatives

Job summary

A comprehensive healthcare network in Hartford, Connecticut is seeking an auditor to conduct compliance audits and collaborate with business owners on corrective actions. Candidates should possess a bachelor's degree and a minimum of two years of health care compliance experience, preferably within a large healthcare system. CPC certification is strongly preferred. The position offers opportunities for career growth and features a competitive benefits program ensuring work/life balance.

Qualifications

• Minimum of two years of health care compliance experience, preferably in a large healthcare setting.
• Certified Professional Coder (CPC) certification strongly preferred.
• CPC certification strongly preferred.
• Experience performing provider documentation and coding audits.
• Knowledge of Medicare/Medicaid, CPT, and ICD-10.
• Experience in physician billing or revenue integrity.

Responsibilities

• Conduct audits in accordance with the approved Revenue Compliance Work Plan.
• Collaborate with business owners to develop action plans for audit findings.
• Monitor corrective actions and provide status reports to leadership.
• Communicate audit results and corrective action plans to stakeholders; monitor progress.
• Stay up to date on coding and billing regulations via professional organizations and research.
• Assist with review/investigation of Compliance Line reports as requested.
• Assist with development and revision of Hartford HealthCare policies and procedures.
• Participate in annual and ongoing risk assessments to update the Revenue Compliance Work Plan.

Skills

Provider documentation and coding audits

Auditing of E/M services

Knowledge of Medicare/Medicaid

Validating charges against medical records

Experience in physician billing

Education

Bachelor’s Degree

CPC certification preferred

Job description

Location Detail: 100 Pearl Street Hartford (10484)

Shift Detail: Monday-Friday 8:00am-4:30pm

Work Location Type: In Person

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

Responsibilities

• Conducts audits in accordance with the approved Revenue Compliance Work Plan or as requested by the Manager or Director.
• Maintains organized files to support audit observations and drafts related audit reports in accordance with agreed upon standards in a timely manner.
• Collaborates with business owner to develop agreed-upon action plans to address findings identified during an audit.
• Communicates audit results and corrective action plans to audit stakeholders. Monitors progress of corrective actions and provides status reports to leadership. Independently validates that corrective action plans are implemented as intended.
• Stays up to date on documentation, coding and billing regulations and requirements via professional organizations and through independent research and education on payor rules, requirements and regulatory guidelines (HHS/OIG, Medicare, Medicaid, NGS, Commercial Insurers, etc).
• Assists with review and/or investigation of Compliance Line reports as requested by the Manager or Director.
• Assists with the development and revision of HHC and Department Policies and Procedures.
• Participates in the annual and ongoing risk assessments to develop and revise the Revenue Compliance Work Plan.

Qualifications

Education:

• Bachelor’s Degree Required

Experience:

• A minimum of two (2) years of health care compliance experience, preferably in a large Healthcare system setting or in a consulting capacity.
• Certified Professional Coder (CPC) certification strongly preferred

Knowledge, Skills and Ability Requirements:

• Experience performing provider documentation and coding audits
• Hands‑on auditing of E/M services and professional claims
• Experience validating charges against medical records
• Strong knowledge of Medicare/Medicaid, CPT, and ICD-10
• Experience in physician billing or revenue integrity

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment