Compliance Auditor

Pay Range

Pay Range: $47.69 - $67.19

About the role

Ensure SEARHC meets federal and state regulations and internal policies in regard to healthcare coding, documentation, and billing practices.

Responsibilities

• Review health records to verify coding and clinical documentation meets applicable coding and billing requirements, Medicare/Medicaid regulations, federal and state laws, and SEARHC policy.
• Conduct Audits: Review health record documentation, claims, coding, policies and processes to identify compliance or non-compliance with SEARHC policies, state and federal laws and regulation, Medicare/Medicaid regulations, and national coding standards.
• Analyze Data: Examine data to identify patterns and trends for compliance or non-compliance.
• Identify Risk: Analyze audit results, data, policies, and processes to assess risk.
• Create audits based on risk assessments, billing practices, new services, Medicare/Medicaid risk areas, Medicare/Medicaid audits, and RAC and PERM audits.
• Prepare Reports: Document audit findings and recommendations. Present reports to the Compliance Director, Chief Legal Officer, Division Vice President, Compliance Committee and Accreditation Governing Body.
• Train and Educate: Prepare and provide training and education to staff in response to audit findings, and staff inquiries.
• Aid the Compliance Director as needed.
• Investigate compliance and HIPAA complaints during the absence of the Compliance Director.

Requirements

• Education, Certifications, and Licenses Required:
• Bachelor’s or AA degree, preferably in health-related field preferred.
• College coursework in medical terminology, anatomy, and physiology.
• Certification as Professional Coder, Coding Specialist, Inpatient/Outpatient Coder.
• Experience Required:
• Minimum of three years’ compliance auditing or health records coding in a healthcare entity.
• Knowledge of Healthcare compliance, health care coding and billing process, medical coding classification (CPT, ICD, HCPCS) rules, Medicare/Medicaid documentation rules, State and Federal medical record requirements and guidelines.
• Medical terminology.
• Electronic health record systems.

Skills

• In Writing reports, preparing training and education presentations, effective communication, problem-solving, reading and interpretating laws and regulations.
• Able to Audit health records for documentation, coding, and billing purposes; investigate compliance concerns; prepare written reports for audits; meet deadlines; understand compliance and regulatory issues; use effective training and communication skills; listen and understand; resolve conflict; analyze data; transform data into meaningful reports; work under pressure; multitask; and function independently.

Benefits

SEARHC offers generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Schedule

Travel may be required to attend meetings, present educational sessions, and present audit findings. Travel is by jet, small aircraft, or ferry.

Qualifications

Required Certifications: Certified Coding Associate - American Health Information Management Association

Skills

• Writing reports, preparing training and education presentations, effective communication, problem-solving, reading and interpretating laws and regulations.
• Able to Audit health records for documentation, coding, and billing purposes; investigate compliance concerns; prepare written reports for audits; meet deadlines; understand compliance and regulatory issues; use effective training and communication skills; listen and understand; resolve conflict; analyze data; transform data into meaningful reports; work under pressure; multitask; and function independently.