Compliance Auditor (medical coding and billing)

Geisinger; United States; Remote; USD 60,000 - 84,000; Full time

Job summary

A leading healthcare organization seeks a Compliance Auditor to support its Revenue Management Compliance department. The role involves conducting audits of medical records, coding, and billing processes, ensuring compliance with regulations, and providing education to staff. The ideal candidate will possess relevant certifications and at least 6 years of experience in the field.

Benefits

Healthcare benefits from day one

Vision and dental coverage

Collaborative work environment

Qualifications

• Minimum one Coding Certification required: Certified Professional Coder, Certified Risk Adjustment Coder, or Registered Health Information Technician.
• Minimum of 6 years relevant experience.

Responsibilities

• Conduct compliance audits to assess medical record documentation and coding adequacy.
• Educate clinical staff on compliance based on audit outcomes.
• Review systems and processes to ensure adherence to regulations.

Skills

Computer Literacy

Multitasking

Organizing

Teamwork

Education

High School Diploma or Equivalent (GED)

Job description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

Yes

Job Summary:

The Compliance Auditor position is responsible for supporting the organization’s Revenue Management Compliance department in developing, implementing, and administering an effective compliance program. Accurately audits and provides compliance research support to physicians, non-physician practitioners, leadership, and administrative staff on documentation and coding requirements. Determines the adequacy of medical record documentation, coding, and billing, using established compliance auditing and research guidelines for hospital and professional services.

Job Duties:

• Performs compliance audits to determine the adequacy of medical record documentation, billing, and coding, utilizing policies, procedures, Federal and State, laws, regulations, and standard coding guidelines. Evaluates whether documentation and coding patterns present a compliance risk to the organization and provides input on recommended solutions.
• Identifies training and education needs through compliance audit results prepared and partners with peers to educate physicians and non-physician practitioners, as determined appropriate.
• Serves as a clinical coding subject matter expert for multiple assigned specialties and utilizes critical thinking when evaluating matters potentially impacting compliance. Maintain an expert level of knowledge with State and Federal healthcare program regulations.
• Works closely with revenue cycle staff to review systems and/or workflows established to ensure compliance with policies, plans, procedures, laws and regulations.
• Reviews service line operations or programs to ascertain whether audit results are consistent with established policies, procedures, procedures, Federal and State regulations.
• Identifies and defines audit scope and criteria. and program of examination for the assigned areas being audited.
• Responsible for surveying the functions and activities in the assigned areas being audited to determine the nature of operations and adequacy of the system to achieve established objectives. Identifies key control points of assigned areas being audited.
• Obtains, analyzes, and appraises evidentiary data and available information as a basis for making an informed, objective opinion on the adequacy and effectiveness of systems and the performance of assigned areas being audited. Makes recommendations for improvement and corrective action plans where appropriate.
• Prepares accurate executive briefs showing the results of assigned areas being audited in accordance with those practices followed within the general scope of the audit parameters.
• Appraises the adequacy of corrective action taken by management to address findings identified through an external audit engagement.
• Provides input in the risk assessment process to determine specific areas of focus for compliance risk mitigation as directed by Compliance or Senior Leadership.

• Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

  *Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Position Details:

Minimum one Coding Certification required:
--Certified Professional Coder - AAPC

--Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC)

--Registered Health Information Technician (RHIT) - American Health Information Management Association

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 6 years-Relevant experience* (Required)

Certification(s) and License(s):

Certified Professional Coder - American Academy of Professional Coders (AAPC), Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association

Skills:

Computer Literacy, Multitasking, Organizing, Teamwork

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.