Employment Spot

Job Description

POSITION SUMMARY:  The Compliance Auditor is a member of the Legal Services; Compliance Department and reports to the Director of Compliance/HIPAA Privacy Officer.  This position contributes to the fulfillment of the Organization's mission by performing audits and monitoring services in compliance with Federal, State, Medicare and Medicaid laws and regulations.  The Compliance Auditor will perform internal audits as directed by the Director of Compliance, such audits to include annual audit plan, and billing and coding audits.


KNOWLEDGE / SKILLS / ABILITIES:

Knowledge: 

• At least 4 years of Billing and Coding experiences
• 2 years experience in performing billing, coding and reimbursement audits
• Requires a CCS-P, CPC, CPC-H or CHC certification
• Requires knowledge of Medicare, Medicaid, physician, Evaluation Management coding, Professional and Facility, private insurance billing.
• Experience in working with time sensitive and confidential projects
• Knowledge of Health Care Compliance

Skills:

• Working Knowledge of MS office (Excel, Word, PowerPoint)
• Ability to present information to a diverse audience
• Must be team oriented
• Highly organized person who can work independently to complete tasks
• Effective to communicate with physicians, Managers and Director level staff

ACCOUNTABILITIES AND ESSENTIAL JOB FUNCTIONS:

Performs organization wide auditing and monitoring and investigates concerns to promote compliance with Federal and State laws and regulations; Medicare and Medicaid regulations; and current billing and coding guidelines.

Perform audits on physician practices, Urgent Care, and Professional billing and coding.  He/She will work closely with the Supervisor of Coding, Manager of the ChargeMaster, Patient Financial Services, and Medical Group Administrator.

Effectively communicates both orally and in writing with the areas that will be audited; performs an in-brief prior to the audit and an out-brief upon completion of the audit.

Develops and maintains detailed audit reports; prepares accurate and timely reports and generate statistical information as requested.

Actively participate in the Compliance Committee and all committees that will involve billing, coding or medical documentation.

Maintains awareness of changing laws, regulations and guidelines and industry developments pertaining to reimbursement compliance with billing and coding.

Works closely with the Director of Compliance and hospital and clinic managers to ensure corrective actions are implemented, including refunds and adjustments.

Determine priorities and work load and complete projects in an accurate and timely manner and performs other duties as assigned.

Establishes and maintains effective communication and interpersonal skills to contribute to a positive work environment.

Adheres to all Harrison Medical Center policies and procedures.

Working Relationships:

Reports to: The Director Corporate Compliance/HIPAA Privacy Officer

Works Closely with:  Director of Compliance, Health Information Management, Supervisor of Coding and ChargeMaster, Patient Financial Services, Medical Group Administrator,  and HMC Managers and Directors.

Job Requirements

EDUCATION REQUIRED:  Associates of Arts or an Associates Technical degree required.

LICENSE / CERTIFICATION / REGISTRATIONS REQUIRED:  CCS-P, CPC, CPC-H or CHC certification

EXPERIENCE REQUIRED:

• At least 4 years of Billing and Coding experience
• 2 years experience in performing billing, coding and reimbursement audits
• Experience in working with time sensitive and confidential projects

KEY WORDS: 
 
Auditor, Billing, Billing Compliance, Compliance, Compliance Auditor, Medical, Medical Billing, Medical Billing Compliance