Compliance Auditor

Covenant Health; Tennessee; On-site; USD 70,000 - 95,000; Full time

Job summary

Covenant Health in East Tennessee is seeking a qualified internal auditor to perform complex compliance audits across charging, coding, documentation and billing processes within our system. The role reports to the Compliance Audit Manager and works with physicians, clinical management, and staff to mitigate risk.

The successful candidate will review Medicare/Medicaid guidelines, stay current on payer rules, and coordinate with various departments to resolve overpayments, document findings, and

Qualifications

• Three to five years of healthcare experience.
• Strong knowledge of healthcare billing and payor rules.
• Experience with problem solving and analytical reviews.
• Proficiency with PCs, Windows, Excel and Word.
• Excellent public relations skills.

Responsibilities

• Identify and evaluate risk areas and provide auditing procedures related to documentation, coding and billing.
• Review regulatory publications and stay current with coding and reimbursement guidelines.
• Analyze charges, CPT coding and modifiers to ensure compliance.
• Coordinate with teams to address over/under payments identified during audits.
• Communicate audit results via reports and presentations to physicians and management.
• Document audit activities and report statistics per policy.
• Assist with special projects and collaborate with HIM, patient accounting, IS staff.
• Review ongoing activities in baseline and periodic audits under leadership.
• Advise facility leaders and staff on audit findings and process improvements.
• Maintain communication with facilities to improve customer service.
• Promote teamwork to achieve goals with accuracy and professionalism.
• Follow policies, complete required education, and participate in quality initiatives.
• Performs other duties as assigned.

Skills

Healthcare billing

Medicare/Medicaid guidelines

Analytical reviews

Regulatory compliance

Microsoft Excel

Word processing

Public relations

RHIT/RHIA/CCS/CPC

Job description

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees. Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.

Position Summary:

Performs complex professional internal auditing. Work involves compliance audit projects for Covenant Health entities as they relate to charging, coding, documentation and billing compliance. Also provides consulting services to the organization’s management and staff and may participate in requested investigations. Maintains all organizational and professional ethical standards. Works independently under limited supervision. Reports to the Compliance Audit Manager.

Responsibilities

• Identifies and evaluates company risk areas and provides auditing procedures related to documentation coding and billing, including reviewing and analyzing findings.
• Reviews and studies all information published by the federal government, fraud alerts, legal advisory opinions, and other publications related to coding, billing and reimbursement compliance, staying abreast of current regulations.
• Performs research and analysis of charges, CPT coding, modifiers and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payor guidelines.
• Coordinates with appropriate parties to complete over or under payments of claim errors identified during audits in accordance with Audit Policy.
• Communicates or assists in communicating the results of audit project via written reports and/or oral presentations to physicians, clinical management, and presents as needed to related committees.
• Documents all audit activities in a designated location; reports statistics and identified problems as directed by the Audit Workflow Process and Policy.
• Assists with special projects as requested by
• Works in conjunction with health information management, patient accounting, information systems and other personnel to assist with implementation of solutions to mitigate risk.
• Under the direction of leadership, reviews and evaluates ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
• Advises, educates and acts as clinical/billing liaison between system-wide facility leaders, department managers and billing staff as designated by manager in relation to audit findings and process improvement initiatives.
• Works independently and demonstrates the ability to successfully locate, interpret and apply regulations with which they may be otherwise unfamiliar, and recognizes situations which necessitate supervision and guidance from leadership.
• Maintains lines of communication with Facilities/Clinics in an ongoing effort to improve the overall quality of customer service.
• Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy, dependability and professionalism.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Three (3) to five (5) years’ experience in health care. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third-Party Payor rules and regulations. Experience in problem solving and analytical reviews. Must be knowledgeable in use of PC's, Windows, Excel and Word Processing. Must have good public relations skills.

Licensure Requirement:

Must have and maintain RHIT, RHIA, CCS, CPC (or equivalent certification), or current TN RN License with equivalent coding experience.