Healthcare Compliance Auditor Consultant (Coding & Analytics)

Thinkbrg; United States, Northern America, Americas; Hybrid; USD 70,000 - 150,000; Full time

Job summary

Thinkbrg seeks a Healthcare Compliance Auditor at the Consultant level to join the HTS group. The candidate will perform regulatory, reimbursement, data analytics and compliance auditing for providers, payers and investors, with a focus on government programs such as Medicare and Medicaid.

The role requires planning and executing medical record audits, developing audit methodologies, and producing client deliverables while applying CPT-4/HCPCS and ICD-10-CM coding guidelines.

Qualifications

• 4-year degree (BS or BA) required.
• Active coding certification from either AAPC (CPC, CPMA) or AHIMA (CCC-P, AOC) required.
• 2+ years of work experience with a focus on healthcare provider billing and coding.
• Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation.
• Proficient in Microsoft Office Suite, especially Excel, PowerPoint, Access, and Word.

Responsibilities

• Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
• Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance
• Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards.
• Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement
• Serve as a subject matter expert on interpretation and application of coding and documentation guidelines
• Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas
• Stay current on coding guidelines.
• Develop analyses using transactional data and/or financial data
• Generate client deliverables and make valuable contributions to expert reports
• Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions
• Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting
• Prioritize assignments and responsibilities to meet goals and deadlines.

Skills

Medical coding expertise

Analytical ability

Attention to detail

Strong communication skills

Time management

Team collaboration

Regulatory knowledge

Education

BS/BA degree

AAPC CPC/CPMA or AHIMA CCC-P/AOC

Tools

Excel

PowerPoint

Access

Word

Job description

Thinkbrg seeks a Healthcare Compliance Auditor at the Consultant level to join the HTS group. The candidate will perform regulatory, reimbursement, data analytics and compliance auditing for providers, payers and investors, with a focus on government programs such as Medicare and Medicaid.

The role requires planning and executing medical record audits, developing audit methodologies, and producing client deliverables while applying CPT-4/HCPCS and ICD-10-CM coding guidelines.