Compliance Auditor - OP-Ambulatory Services
About the position This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded healthcare payors across the Baptist Physician Enterprise (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance related coding and billing questions and provide feedback on audit findings and necessary remediation/corrective action requirements. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards. Responsibilities • Audits outpatient (OP)/ambulatory service claims to assure a minimum of 95% accuracy and recommends corrective action, education, and training related to audit results. • Audits the assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on sampled outpatient/ambulatory cases. • Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided. • Utilizes Healthicity or other compliance and audit systems, develops and maintains comprehensive audit reports and documentation of each audit performed, cases sampled, and audit findings. • Meets with audited providers/department leadership to present audit findings and required remediation/corrective actions to cure coding and billing errors; effectively educates and promotes awareness of compliant billing and coding requirements. • Provides information to physicians and other health care staff regarding current coding practices and changes in state and federal regulations and guidelines. • Researches and resolves problems referred by auditees and provides prompt feedback. • Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and billing requirements. • Participates in and provides education sessions as needed on specific coding topics at huddle meetings and other forums. • Maintains responsibility for operational excellence; ensures the delivery of quality audit services in accordance with applicable policies, procedures, and professional standards. Requirements • Bachelor's Degree in Health Information Management, Five years of related experience may be considered in lieu of degree. • 5 years Health care compliance experience including coding compliance. • 3 years Health care compliance auditing of coding and billing practices. • Experience with the following applications and systems: Healthicity, Altera Sunrise (formerly Allscripts), Hyland MRM, Clintegrity, FinThrive, and MS Office Suite and Excel in particular. Nice-to-haves • Experience with Healthicity, Altera Sunrise (formerly Allscripts), Hyland MRM, Clintegrity, FinThrive, and MS Office Suite and Excel. Apply tot his job