Compliance Auditor

About the role

Analyze and audit LMC systems of the Physician Network and the hospital medical record data to determine if charges billed are supported by appropriate medical documentation. Monitor risk areas and conduct focused audits as identified by the Compliance Audit Manager. Prepare reports and meet with physicians and Advanced Practice Providers (APPs) to review audit results.

Qualifications

• Education: Bachelor’s Degree in Business or Related Field
• Experience: 3 years of directly related experience
• Substitutable combinations: High School Diploma with 7 years directly related experience; Associate’s Degree with 5 years directly related experience
• Required certifications: Certified Professional Coder (CPC) through AAPC or Certified Coding Specialist (CCS) through AHIMA
• Additional certification: Certified Professional Medical Auditor (CPMA) — not required at placement but must be obtained within 1 year of entry date
• Skills: Strong problem-solving skills; ability to articulate complex issues and detailed action plans orally and in writing while representing the organization professionally; ability to communicate with physicians, APPs, senior administrators, and department staff; proficient in Microsoft Office

Responsibilities

• Conduct audits of hospital and Physician Network records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid, and third-party billing regulations and/or standards
• Assist the Chief Compliance Officer in investigating inquiries related to erroneous billing and coding of services
• Work closely with Health Information Management and Revenue Integrity to conduct coding reviews and inquiries
• Draft formal written reports summarizing medical record findings for review
• Provide education on subjects pertinent to reviews conducted and any coding and billing changes to appropriate LMC staff
• Determine whether medically necessary criteria are met as required by CMS and the fiscal intermediary through National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and other guidance in effect at the time of review
• Participate in risk assessment of areas of focus designated by Recovery Audit Contractors, MIC, OIG, ZPIC, and other regulatory agencies
• Consult with Revenue Integrity personnel and the Compliance Audit Manager when relevant issues of federal and state healthcare billing law and regulations are discovered that create overpayments
• Stay current on ICD-10, CPT-4, and HCPCS coding changes, compliance issues, and regulations; communicate and provide updates regarding changes in regulations, policies, or procedures pertaining to the Compliance Program
• Treat patients, fellow employees, and all individuals encountered while representing the organization with courtesy and respect in keeping with the LMC vision
• Adhere to organization-wide policies
• Perform all other duties as assigned

Schedule

Full-time, day shift, 7:00 am – 5:00 pm

Benefits

• Day-one medical, dental, and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• 403(b) match plan eligible day one — employer matches dollar-for-dollar up to 6%
• Employer-paid life insurance equal to 1× salary
• Optional supplemental life insurance with low-cost premiums up to 3× salary
• Adoption assistance
• Employer-paid short-term and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

Location

Nearest major market: Columbia, South Carolina