Compliance Auditor (Urology)

Paycom; Southlake (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

GI Alliance is seeking a Compliance Auditor to research and analyze medical records, validate coding, and prepare reports with corrective action recommendations. You will examine claims for compliance, identify fraud risks, and provide second-level billing reviews to ensure adherence to regulations and policies.

Interaction with physicians about documentation and coding is expected. The role requires updating knowledge of ICD-10, CPT, and HCPCS coding, plus strong proficiency in Microsoft

Qualifications

• High School Diploma or GED required.
• AAPC CPC certification required; CPMA within 1 year preferred? stated in doc.
• Proficient with ICD-10, HCPCS II and CPT codes; knowledge of billing guidelines.

Responsibilities

• Audits physician charts to identify incorrect coding and prepares reports.
• Examine claims for compliance with billing guidelines and identify fraud risks.
• Report coding patterns and suggest corrective actions to management.
• Research errors or missing documentation to ensure accurate coding.
• Provide second-level review of billing for compliance with policies.
• Interact with physicians on policies, procedures, and documentation.
• Verify medical record documentation (electronic and handwritten).
• Assign ICD-10, HCPCS/CPT codes for diagnoses and procedures in inpatient/outpatient settings.

Skills

Word

Excel

PowerPoint

ICD-10

CPT/HCPCS

Regulatory knowledge

Education

High School Diploma/GED

AAPC CPC certification

Tools

Microsoft Office

Job description

Duties of this position include, but are not limited to, the following:Position purposeThe Compliance Auditor will be responsible for researching and analyzing the medical records where there is a discrepancy in coding, validating the coding, and preparing reports that summarize audit findings and provide recommendations for corrective actions, if warranted.Responsibilities/Duties/Functions/Tasks:Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues.Examine claims for compliance with relevant billing and processing guidelines and identify opportunities for fraud and abuse prevention and control.Reports coding patterns identified within the audit process to the Manager and identifies corrective measures for compliance problems.Responsible for researching errors or missing documentation from medical records to provide accurate coding processes.Provides second-level review of billing performance to ensure compliance with legal and procedural policies and adherence to regulations prohibiting unbundling and other questionable practices.Interacts with physicians regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.Performs quality assessment of records, including verification of medical record documentation (both electronic and handwritten).Abstract and assign the appropriate ICD-10, HCPCS/CPT codes, including Level I & II modifiers as appropriate, for all diagnoses and procedures performed in outpatient and inpatient settings.Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations using current CPT, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.Manage time effectively to meet all required deadlines and timeframes for client and department needs.Collaborate in a team environment with the Department Manager and other staff on a regular basis.Enhances professional growth and development through in-service meetings, educational programs, conferences, etc.Performs other related duties as required and assigned.QualificationsEducation: High School Diploma/GED, Professional Coding Certification with American Academy of Professional Coders AAPC: Certified Professional Coder (CPC) is required. Obtain Certified Professional Medical Auditor (CPMA) within one year of employment.Experience: Minimum of 3 years’ experience in health care operations and coding experience required; Evaluation and Management and/or Gastroenterology coding experience preferred.Qualifications:Extensive knowledge of ICD-10, HCPCS II and CPT codesProficient in Word, Excel, and PowerPoint.Skilled in creating summary spreadsheets, documents, reports, and presentations.Knowledge of current third-party billing and collection regulations and requirements.Good interpersonal skills; written and verbal communication skills both with administrative and clinical staff.Equipment Operated: This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.Work Environment: Professional and comfortable office environment.Physical Requirements: Position may involve standing, sitting, bending, and reaching. May work at computer monitors for prolonged periods with danger of eye strain and muscle pain. Could cause stress if workload is heavy. May on occasion require light lifting of no greater than 20 pounds and some offsite travel.GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.No phone calls or agencies, please.EEO/AA-M/F/disabled/protected veteran