Physician Compliance Auditor - Professional Billing - Hybrid - FTE - Days

Grade Health System; Atlanta (GA); Hybrid; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Physician Compliance Auditor to ensure coding accuracy and compliance. This dynamic role involves conducting audits, training staff, and developing educational materials to enhance coding practices. The ideal candidate will have extensive experience in coding and auditing, with strong communication skills to liaise with both internal teams and external auditors. Join a forward-thinking organization that values diversity and offers a hybrid work environment, where your contributions will directly impact the quality of healthcare services provided. This is a fantastic opportunity for those passionate about compliance and education in the medical field.

Qualifications

• 5+ years of coding experience required, with 3 years in auditing.
• Certifications like CPC, RHIA, or RHIT preferred.

Responsibilities

• Conduct compliance audits and establish monitoring processes.
• Lead training sessions on billing and coding information.
• Ensure coding quality and compliance with regulations.

Skills

Auditing

Compliance Monitoring

Effective Communication

Organizational Skills

Coding Accuracy

Education

High School Diploma/GED

Certified Professional Coder (CPC)

Bachelor's/Associate's Degree

Tools

ICD-10

CPT Classifications

Job description

Physician Compliance Auditor - Professional Billing - Hybrid - FTE - Days

Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages of your career, you can find a rewarding career at Grady!

Location: Atlanta, GA

Job Type: FTE

Shift/Schedule: Days

This is a remote role, but the ideal candidate will be required to come into the office occasionally to meet with the providers.

Summary

The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor performs clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director and Compliance Director.

This position requires effective communication with internal stakeholders and external auditors. Candidates should possess excellent organizational skills to ensure accuracy and timeliness of audit results.

Assess the educational needs of physicians regarding coding and documentation and direct the development of effective regularly scheduled educational programs that meet physician needs. Serve as the primary resource to physicians for documentation and coding issues.

Responsible for conducting coding and billing training programs for billing and coding specialists and physicians. Create presentations, develop learning materials, handbooks, and other training materials. Conduct coding and data quality reviews and prepare complex reports as required. Ensure all Revenue Cycle coding activities comply with clinical billing standards and government regulations, focusing on hospital inpatient procedures and specialty physician services.

MINIMUM EDUCATION REQUIRED:

High School Diploma/GED required. Certified Professional Coder (CPC), RHIA, RHIT, AAPC, or AHIMA accredited preferred. Bachelor's/Associate's Degree preferred.

MINIMUM EXPERIENCE REQUIRED:

Five (5) years of coding experience required, with at least three (3) of those years in auditing.

ADDITIONAL PREFERRED QUALIFICATIONS:

One of the following certifications: CHC, CIA, CHA, CHIAP, CCS, CCA, CCS-P, or CPC-I.

KEY RESPONSIBILITIES:

1. Conduct compliance audits, report results, research/investigate issues, and establish compliance monitoring processes.
2. Serve as a liaison between Compliance Vendor and Revenue Cycle.
3. Lead training sessions on current billing and coding information in the medical field.
4. Develop curriculum and training handbook and create presentations.
5. Perform quality assurance reviews to assess comprehension of training efforts and assure coding quality.
6. Research updated coding information and communicate changes to physicians and billing staff.
7. Provide continual coding and payer updates.
8. Maintain knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures.
9. Identify elements of a medical record's structure and content and code abstracting.
10. Work closely with physicians to ensure that charges are being accurately and compliantly captured, coded, and billed.
11. Build strong relationships and facilitate effective communication between hospital and physician-based Revenue Cycle.

Equal Opportunity Employer - Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.