Compliance Auditor, Intermediate - CCP

UPMC; Wexford (Allegheny County); Remote; USD 70,000 - 90,000; Full time

Job summary

Join a leading healthcare provider as a Compliance Auditor, Intermediate, where you'll conduct audits and ensure compliance with state and federal regulations. This full-time role supports UPMC's Children’s Community Pediatrics and requires a deep understanding of coding and medical billing practices. Ideal candidates will have substantial auditing experience and necessary certifications. If you're ready to make a difference and improve healthcare compliance, apply today!

Qualifications

• 3 or more years of experience in medical coding, billing, auditing and compliance.
• Extensive knowledge of CMS and third-party payer coding.
• Licensure such as CCS, CPC, or CPMA required.

Responsibilities

• Conduct UPMC wide auditing and monitoring for compliance.
• Validate appropriateness of coding documentation.
• Prepare written reports and conduct training sessions.

Skills

Medical Coding

Auditing

Compliance Regulations

Documentation

Education

High School Diploma

Associates Degree

Job description

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Are you passionate about helping kids be their best selves?

UPMC Children's Community Pediatrics is hiring a Full-Time Compliance Auditor, Intermediate to support the office Remotely.

Must live in the state of PA.

Responsibilities:

• Conduct UPMC wide auditing and monitoring to ensure coding/documentation combinations and medical record documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards.
• 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.
• Conduct audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy.
• Develop concise and well referenced audit workpapers.
• Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.
• Conduct post-audit compliance training sessions for physicians and non-physician practitioners as audit results dictate. These training sessions will include, but are not limited to, provision of education specific to the issues found on audit and will be largely based on the documentation, coding and billing rules as set forth by CMS and other relevant Federal and State regulatory agencies.
• Maintain current knowledge and understanding of regulatory trends and changes in coding policy and reimbursement methods.
• High School Diploma or equivalent required.
• Associates Degree or comparable technical school diploma is preferred.
• 3 or more years of experience in medical coding, billing, auditing and compliance.
• Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (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 strongly preferred.
  
  

Licensure, Certifications, and Clearances:

Clearances:

• Act 34
  
  

One of the following required:

• 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)
• Registered Nurse (RN)
  
  

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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