Sr. Compliance Auditor

Johns Hopkins University; Baltimore (MD); Remote; USD 73,000 - 129,000; Full time

Job summary

An established industry player is looking for a Sr. Compliance Auditor to lead training and support for medical billing and documentation compliance. In this pivotal role, you will conduct audits, analyze coding practices, and collaborate with clinical departments to enhance documentation standards. This position offers a unique opportunity to influence compliance practices within a renowned institution, ensuring adherence to regulations while fostering a culture of continuous improvement. If you are detail-oriented, possess strong analytical skills, and are passionate about healthcare compliance, this role is perfect for you.

Qualifications

• 5 years of auditing/billing compliance experience required.
• Must have a professional coding certification by start date.
• Detail-oriented with strong analytical and communication skills.

Responsibilities

• Conducts audits on medical record documentation adequacy.
• Provides training to staff on documentation and billing compliance.
• Analyzes coding patterns and recommends solutions.

Skills

Medicare regulations

Medical Terminology

CPT coding

ICD-9 coding

Analytical skills

Communication skills

Organizational skills

Training experience

Education

Bachelor's Degree in health care-related or business-related field

Professional coding certification (CCS-P, CPC, RHIA or RHIT)

Tools

Epic Billing and Accounts Receivable system

EPR

Meditech

Eclypsis

IDX

Microsoft Word

Excel

Outlook

Job description

We are seeking a Sr. Compliance Auditor who will provide on-going training and support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the clinical departments, Physicians Billing Service, and the Johns Hopkins Health System Compliance Office. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program. Prepares reports for the Sr. Director, Director, and clinical departments regarding the status or results of the reviews. Summary results are presented to the Clinical Practice Association’s Board of Governors, the University’s Trustee Committee for Audits and Insurance and other appropriate offices within the School of Medicine or Johns Hopkins Medicine.

Specific Duties & Responsibilities

• Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
• Verifies and corrects as necessary, the audit work completed by the Billing Compliance Auditors or other Sr. Auditors/Trainers.
• Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
• Assists departments and providers in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities.
• Conducts training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
• Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed.
• Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.
• Regularly monitors potential billing problems and/or billing errors identified by each departments’ professional fee billing office.
• Prepares and revises as needed a Compliance Training Manual for routine and special training programs.
• Assists in the development of medical record documentation standards and requirements related to clinical services billing.
• Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.
• Performs other compliance related activities as necessary.

Scope of Responsibility

• Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division.
• Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

Decision Making

• On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
• Routinely handles confidential patient information and sensitive financial information.

Authority

• Sr. Billing Compliance Auditor/Trainer may be asked to assist with training new staff or correcting the work of others.
• Identifies and suggests process and operational improvements.

Communications

• Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

Additional Knowledge, Skills & Abilities

• Recent experience with Medicare regulations required.
• Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required.
• Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
• Must be able to learn quickly and work independently to address a variety of complex issues.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.
• Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.
• Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.
• Demonstrated communication, analytical and organizational skills are essential.
• Demonstrated training or teaching experience required.
• Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.
• Must be self-motivated and comfortable working independently, as a team leader and as a team member.

Physical Requirements

• Sitting in seated position for extended periods of time.
• Reaching by extending hand(s) or arm(s) in any direction.
• Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.

Minimum Qualifications

• Bachelor's Degree in health care-related or business-related field.
• Five years of auditing/billing compliance required.
• A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.

• Additional education may substitute for required experience and additional experience may substitute for required education, to the extent permitted by the JHU equivalency formula.

Preferred Qualifications

• Experience with Epic Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, IDX and other clinical information systems.
• Seven years of experience.
• Additional coding certifications.

Classified Title: Sr. Billing Compliance Auditor
Job Posting Title (Working Title): Sr. Compliance Auditor
Role/Level/Range: ATP/04/PE
Starting Salary Range: $73,300 - $128,300 Annually ($100,800 targeted; Commensurate w/exp.)
Employee group: Full Time
Schedule: M-F 8:30am-5pm
FLSA Status: Exempt
Location: Remote
Department name: Office of Compliance: Prof Fee Services
Personnel area: School of Medicine