Healthcare Compliance Audit Lead

DHR Health; Edinburg (TX); Vor Ort; USD 90.000 - 115.000; Vollzeit

Zusammenfassung

DHR Health in Edinburg, TX seeks a Compliance Audit Manager to lead retrospective and pre-bill audits, ensuring accurate coding and data integrity for reimbursement. The role emphasizes oversight of audits, educator feedback, and regulatory compliance across outpatient and inpatient services.

The candidate should have 3+ years hospital coding experience, CCS/CCA/COC/CPC certification, and strong communication skills to interact with leadership and providers.

Qualifikationen

• Three (3) years of hospital coding experience.
• CCS, CCA, COC or CPC certification required.
• Good written and verbal communication skills are required.
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of management.

Aufgaben

• Develop, conduct, and oversee retrospective revenue cycle audits, prospective (pre-bill) audits, and coding validation activities, including Cerner Charge Assist reviews, for high-risk and below-benchmark E/M services.
• Communicates audit findings, educational recommendations, and corrective feedback to providers and leadership to promote coding accuracy, documentation integrity, and regulatory compliance.
• Monitor and tracks RAC audit findings, results, and corrective action plans; maintains documentation and reports outcomes to support compliance initiatives.
• Manage outsourced audit activities by providing quality oversight, educational feedback, and corrective guidance to external auditors.
• Monitor CMS TPE topics and conduct focused outpatient and inpatient E/M audits to ensure compliance with regulatory requirements.
• Perform data analysis of coding accuracy, billing performance, reimbursement outcomes, denial trends, and provider documentation patterns to identify risks and opportunities for improvement.
• Design, develop, and maintain audit tools, reports, and monitoring processes to evaluate the accuracy of clinical coding and documentation practices.
• Monitor Tableau dashboards and distribute provider census metrics, physician documentation delinquency reports, and other operational performance data.
• Communicate audit findings, compliance recommendations, coding guidance, and documentation best practices to physicians, providers, leadership, and staff.
• Conduct new physician orientation and onboarding education on coding, documentation, billing compliance, reimbursement methodologies, organizational policies, HIPAA privacy and security standards, and regulatory requirements to support accurate documentation, compliant billing practices, and protection of patient health information.
• Develop and deliver coding, documentation, billing, and compliance education for resident physicians and GME programs.
• Serve as a subject matter expert and resource for providers and staff regarding coding standards, documentation requirements, reimbursement methodologies, and regulatory guidelines.
• Collaborate with leadership and management to address clinical documentation, coding, compliance, reimbursement, and revenue integrity issues.
• Maintain current knowledge of coding guidelines, CMS regulations, payer requirements, reimbursement methodologies, and industry best practices.
• Adhere to AHIMA Standards of Ethical Coding, official coding guidelines, regulatory requirements, and organizational policies.
• Support professional development initiatives through continuing education, mentoring, precepting, competency development, and departmental goal achievement.
• Other duties as assigned.

Kenntnisse

Outpatient auditing

ICD-10-CM coding

CPT coding

Communication skills

Reading and writing English

Regulatory compliance awareness

Ausbildung

High School diploma or GED

CCS/CCA/COC/CPC certification

Tools

Cerner Charge Assist

Tableau

Database/Spreadsheet design

Jobbeschreibung

DHR Health in Edinburg, TX seeks a Compliance Audit Manager to lead retrospective and pre-bill audits, ensuring accurate coding and data integrity for reimbursement. The role emphasizes oversight of audits, educator feedback, and regulatory compliance across outpatient and inpatient services.

The candidate should have 3+ years hospital coding experience, CCS/CCA/COC/CPC certification, and strong communication skills to interact with leadership and providers.