Compliance Auditor, Associate

UPMC; Pittsburgh (Allegheny County); On-site; USD 51,000 - 144,000; Full time

Job summary

An established industry player is seeking a Compliance Auditor, Associate to ensure the integrity of coding and billing processes in healthcare. This role is vital for maintaining compliance with state and federal regulations. You'll conduct audits, validate codes, and provide training based on audit results, all while working in a collaborative environment focused on professional growth. Join a team that values precision and strategic thinking, and make a significant impact in a leading healthcare organization.

Qualifications

• 1 year of experience in medical coding, auditing, billing, and compliance.
• Knowledge of CMS and third-party payer coding regulations preferred.

Responsibilities

• Conduct comprehensive audits to ensure compliance with regulations.
• Validate coding and documentation for accuracy in billing processes.

Skills

Detail-oriented

Analytical Skills

Interpersonal Skills

Organizational Skills

Communication Skills

Education

High School Diploma

Associate's Degree

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Job description

1 week ago Be among the first 25 applicants

Join UPMC Corporate Finance as a Compliance Auditor, Associate!

Are you detail-oriented and passionate about ensuring compliance in healthcare? UPMC Corporate Finance is looking for a dedicated and meticulous Compliance Auditor, Associate to join our team. This role is crucial in maintaining the integrity of our coding and billing processes, ensuring they meet state and federal regulations.

Key Responsibilities:

• Comprehensive Auditing: Conduct UPMC-wide auditing and monitoring to ensure that coding/documentation combinations and medical record documentation adequately support services coded and billed in accordance with appropriate state and federal regulations and standards.
• Code Validation: Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCD and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.
• Post-Audit Training: Conduct post-audit compliance training sessions for physicians and non-physician practitioners based on audit results. These sessions will provide education specific to the issues found during audits and will be based on documentation, coding, and billing rules set forth by CMS and other relevant federal and state regulatory agencies.
• E/M and External Audits: Complete Evaluation and Management (E/M) audits and external audits to ensure comprehensive compliance.
• Reporting Assistance: Assist with reporting audit numbers for administration and board books, ensuring accurate and timely information is provided.
  
  

What Sets Us Apart?

• Impactful Work: Your role will directly contribute to the accuracy and compliance of our healthcare services, ensuring we meet all regulatory standards.
• Professional Growth: Gain valuable experience in auditing and compliance within a leading healthcare organization, with opportunities for career advancement.
• Collaborative Environment: Work alongside a team of dedicated professionals who are committed to excellence and continuous improvement.
  
  

If you're ready to take on a challenging and rewarding role that offers significant impact and growth opportunities, we want to hear from you! Apply now and join a team that values precision, integrity, and strategic thinking.

• High School Diploma or equivalent required.
• Associate's degree or comparable technical school diploma is preferred.
• 1 year of experience in medical coding, auditing, billing and compliance.
• Knowledge of CMS and third-party payer coding, billing, and documentation compliance regulations preferred (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
• Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.
• Experience in an academic medical center setting is preferred.
• Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.
• Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.
• Must have strong interpersonal, organizational, analytical and communication skills.
• Ability to work in a fast-paced environment.
• Ability to manage multiple tasks and projects.
• Ability to forge strong interpersonal relationships within the department and with other departments. Licensure, Certifications, and Clearances: (Preferred)
• Certified Coding Specialist (CCS)
• Certified Inpatient Coder (CIC)
• Certified Evaluation & Management Coder (CEMC)
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder (CPC)
• Certified Medical Coder (CMC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Licensed Professional Nurse (LPN) or
• Registered Nurse (RN)
• Act 34
  
  

UPMC is an Equal Opportunity Employer/Disability/Veteran

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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