Compliance Auditor (Urology) (32055)

GI Alliance; Southlake (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

GI Alliance invites applications for a Compliance Auditor to research and analyze medical records with coding discrepancies, validate coding, and prepare reports with recommendations for corrective actions.

The role includes auditing physician charts, reviewing billing for compliance, and communicating with physicians on documentation standards. Candidates should hold CPC/CPMA or equivalent credentials and have 3+ years in healthcare coding and operations.

Qualifications

• Extensive knowledge of ICD-10, HCPCS II and CPT codes.
• Experience with auditing and compliance in healthcare payments.
• Strong ability to compile findings into reports and recommendations.

Responsibilities

• Conduct physician chart audits to identify incorrect coding.
• Examine claims for compliance with billing guidelines and identify opportunities for fraud prevention.
• Report coding patterns and identify corrective measures for compliance problems.
• Research errors or missing documentation to provide accurate coding processes.
• Provide second-level review of billing performance for compliance with policies.
• Interact with physicians on billing and documentation policies and procedures.
• Verify medical record documentation and assign ICD-10, HCPCS/CPT codes.
• Stay current with coding guidelines and federal regulations.
• Collaborate with the Department Manager and staff to meet deadlines.

Skills

ICD-10 coding knowledge

HCPCS II coding

CPT coding expertise

Written and verbal communication

Data analysis

Education

High School Diploma/GED

AAPC CPC

CPMA certification

Tools

Word

Excel

PowerPoint

Job description

Duties of this position include, but are not limited to, the following:

Position purpose

The 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.

Qualifications

Education: 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.

• Extensive knowledge of ICD-10, HCPCS II and CPT codes
• Proficient 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.

EEO/AA-M/F/disabled/protected veteran