Compliance Auditor - MPG - FT - Days - MHS

CO010 Memorial Healthcare System; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Memorial Healthcare System is seeking an experienced audit professional to lead reviews of physician evaluation and management and procedure coding to ensure compliance with official guidelines and medical necessity.

You will prepare formal audit reports for executives, participate in investigations, monitor regulatory compliance, and validate documentation supporting coding decisions across MPG physicians. A strong background in AHIMA/AAPC certifications and CMS disclosures is preferred.

Qualifications

• Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
• Associates degree in Health Information Management, Health Information Technology, Health Informatics, or related field.
• AHIMA CCA and/or AAPC CPC/CPMA/HCC/CRC certifications.
• Knowledge of ICD-10 coding guidelines, medical necessity and regulatory compliance.

Responsibilities

• Prepare formal audit report of background, steps and findings for executive leadership and the Board of Commissioners.
• Participates in investigations and responds to questions, issues, reports by federal and state agencies.
• Monitor and assess compliance with laws and System policies to identify deviations and recommend corrective action.
• Follow up on audit findings to ensure corrective action plans are effective.
• Ensure compliance with regulatory agencies governing healthcare delivery and payers.
• Communicate with and educate employees on the Memorial Healthcare System Compliance Program.
• Audit medical records to verify documentation supports medical necessity and code accuracy.
• Review MPG physician coding and billing for E/M visits and procedures.
• Research CMS disclosures for financial relationships and verify disclosures on COI questionnaires.

Skills

Accountability

Analysis & decision making

Customer service

Effective communication

Healthcare industry

Problem solving

Responding to change

Standards of behavior

Education

Associates degree in Health Information Management

CCA - AHIMA

CPMA - AAPC

CPC - AAPC

HCC - AAPC

CRC - AAPC

Bachelor’s degree preferred

Job description

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary: Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.

Responsibilities

• Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.
• Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.
• Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.
• Follow up on audit findings to ensure that the corrective action plans are effective.
• Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.
• Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.
• Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.
• Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.
• Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.

Competencies

• ACCOUNTABILITY
• ANALYSIS AND DECISION MAKING
• CUSTOMER SERVICE
• EFFECTIVE COMMUNICATION
• HEALTHCARE INDUSTRY
• PROBLEM SOLVING
• RESPONDING TO CHANGE
• STANDARDS OF BEHAVIOR

Education and Certification Requirements

Associates (Required) Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC)

Additional Job Information

Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead.

Required Work Experience

Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.

Other Information

Additional Education Info: Associate's degree in Health Information Management, Health Information Technology, Health Informatics, or related field. Bachelor’s Degree preferred.

Additional Certification Info

• Certified Coding Associate (CCA from AHIMA)
• CPC - Certified Professional Coder – American Academy of Professional Coders (AAPC)
• HCC - Hierarchical Condition Category – American Academy of Professional Coders (AAPC)
• CRC - Certified Risk Adjustment Coder – American Academy of Professional Coders (AAPC)
• CPMA - Certified Professional Medical Auditor – American Academy of Professional Coders (AAPC)

Working Conditions and Physical Requirements

• Bending and Stooping = 40%
• Climbing = 40%
• Keyboard Entry = 80%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 40%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 40%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 60%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 40%
• Standing = 80%
• Walking = 80%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 0%
• Seeing - Far = 80%
• Seeing - Near = 80%
• Bio hazardous Waste = 40%
• Biological Hazards - Respiratory = 40%
• Biological Hazards - Skin or Ingestion = 40%
• Blood and/or Bodily Fluids = 40%
• Communicable Diseases and/or Pathogens = 40%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 60%
• Gas/Vapors/Fumes = 40%
• Hazardous Chemicals = 40%
• Hazardous Medication = 0%
• Latex = 60%
• Computer Monitor = 80%
• Domestic Animals = 0%
• Extreme Heat/Cold = 40%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 60%
• Needles/Sharp Objects = 40%
• Potential Electric Shock = 40%
• Potential for Physical Assault = 40%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%
• Shift: Primarily for office workers - not eligible for shift differential

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

Veteran’s Preference

Memorial Healthcare System provides preference as part of our commitment to honoring the service and sacrifice of veterans in alignment with state regulations. Veteran’s Preference allows for the first choice in interviewing, hiring, retention, and promotion after deployment when all other applicant qualifications are equal. However, Veteran's Preference does not guarantee a job. Who is eligible for Veteran’s Preference? We are proud to offer preference to internal and external applicants who identify within these categories: veterans, disabled veterans, spouse of a disabled veteran, unremarried veteran widow/widower, certain family members, active reservists and members of the National Guard. What should I do if I am eligible for Veteran’s Preference? You must claim your Veteran’s Preference status on your application. If selected for a job, you must provide documentation regarding your status. How does Memorial verify that someone is eligible for Veteran’s Preference? We require specific documentation as determined by the basis for which someone claims preference. For example, the documentation for a disabled veteran is different from the documentation required for the spouse of a veteran killed in the line of duty. How often can an eligible person claim Veteran's Preference at Memorial? There is no limit to how often internal or external applicants can use preference when a job is posted externally on our career website or elsewhere. What if there are two equally qualified, preference-eligible job applicants? In this case, the selection is based on the eligibility category in accordance with Florida law. First preference is given to: An honorably discharged veteran who has served on active duty and has a service-connected, compensable disability. A spouse of a person who has a total, permanent, service-connected disability and cannot qualify for employment. A spouse of a person missing in action, captured or forcibly detained or interned by a foreign government or power. What do I do if I am denied Veteran's Preference? If you feel you have been unfairly denied Veteran’s Preference by Memorial Healthcare System, please contact [e-mail]. You may also file a complaint with the Florida Department of Veterans’ Affairs (FDVA).

Legal and Notices

Florida Civil Rights Act, Equal Employment Opportunity is the Law (EEO), Family and Medical Leave Act (FMLA), Employee Polygraph Protection Act (EPPA), E-Verify Participation Notice – English, Right To Work Notice – English, E-Verify Participation Notice – Spanish, Right To Work Notice – Spanish. Memorial Healthcare System is subject to the Florida Public Records Law. All information provided in connection with your application for employment will be a public record and subject to release upon request, unless considered exempt or confidential.