Compliance Risk Auditor

Position Responsibilities

• Perform risk audits in accordance with UI Health Care policies and guidelines, federal rules and regulations, and other guidelines governing compliant coding, billing, and documentation.
• Adhere to audit scope and perform high level, self-guided research on all required topics (coding/billing rules, federal regulations, internal policy, etc.) necessary to perform audit.
• Maintain a high level of understanding and awareness of CPT/HCPCS guidelines and federal coding and billing regulations, compliance program standards, and documentation requirements.
• Track and organize findings, communication, resources, and all other items pertaining to audits in shared folders in an accurate and timely manner.
• Ensure timely reporting and validation of risk audit findings. Discuss findings with JOC Risk Audit Supervisor, and other leaders as needed.
• Compose detailed summaries of audit findings to be sent via email to providers, clinical department administrators, coders, and other hospital staff in a timely manner.
• Communicate and resolve issues and disagreements with coding and providers as they arise during audit.
• Conduct audit meetings, in person or virtually, related to findings with providers, coders, and clinical department administrators, requiring a high level of organization and communication for quality delivery of results.
• Prepare complex reports to be presented to JOC leadership that detail audit findings which include accurate results, trend identification, organizational impact, and corrective action.
• Maintain unit’s SOP documents.

Required qualifications

• A Bachelor’s degree in Health Information Management or related field, or an equivalent combination of education and experience.
• Certification as RHIT, RHIA, CPC, or equivalent through a nationally recognized credentialing body such as AHIMA or AAPC.
• 1-3 years coding experience (inpatient, outpatient, professional, hospital or a combination).
• Experience working with multiple technology platforms such as an electronic medical record, coding software, and Microsoft Office Suite (Word, Excel, PowerPoint).
• Excellent written and verbal communication and interpersonal skills; ability to effectively transmit, receive and interpret ideas, information, and needs through appropriate communication methods and behaviors.
• Demonstrated ability to accurately prepare reports and maintain associated electronic records.
• Ability to maintain confidentiality.
• Demonstrated experience working effectively in a welcoming and respectful workplace environment.

Desired Qualifications

• Experience with Epic.
• Knowledge of hospital and professional billing concepts.
• Data collection, analytical skills.
• Knowledge of various payer billing requirements as well as billing rules and regulations for Medicare, Medicaid, and other federal payer plans.