Healthcare Compliance Audit Analyst, CPC, CCS-P, CPMA
Job Description:
• Conduct physician/provider and facility documentation audits
• Ensures accuracy of data entered into the CD Internal Audit Database and prepares reports for audited providers, department leadership, and organization leadership
• Analyze audit data and provides summary feedback to clinic and billing staff, making recommendations for improvement
• Works with the billing and coding departments to determine charge corrections and refunds resulting from compliance audits
• Works closely with the billing department to help minimize denial issues so that appropriate reimbursements are achieved
• Receives and responds to audit, documentation, and coding review requests from the billing department
• Performs research for numerous billing and coding scenarios
• Provide input in the development and improvement of procedures used to complete the audit function
• Assist in conducting formal/informal education sessions for the purpose of educating and training physicians, non-physician providers, and other staff
• Identify additional opportunities to improve education of physicians, non-physician providers and staff
• Working with the billing and coding departments, prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels
• Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff
• Based on types of questions/issues received, identify education/awareness opportunities and guidance topics
Requirements:
• Experience with using and navigating through an electronic medical record system
• Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required
• Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required
• Ability to think abstractly and concretely required
• Ability to develop reports, presentations, and spreadsheets required
• Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access, and Internet Explorer is required
• Outstanding verbal and written communication skills is required
• Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required
• Ability to gain the trust and confidence of the providers, compliance team and billing staff
Benefits:
• Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans
• HSA / FSA
• 401(k) matching
• an Employee Assistance Program (EAP) and more
• Conduct physician/provider and facility documentation audits
• Ensures accuracy of data entered into the CD Internal Audit Database and prepares reports for audited providers, department leadership, and organization leadership
• Analyze audit data and provides summary feedback to clinic and billing staff, making recommendations for improvement
• Works with the billing and coding departments to determine charge corrections and refunds resulting from compliance audits
• Works closely with the billing department to help minimize denial issues so that appropriate reimbursements are achieved
• Receives and responds to audit, documentation, and coding review requests from the billing department
• Performs research for numerous billing and coding scenarios
• Provide input in the development and improvement of procedures used to complete the audit function
• Assist in conducting formal/informal education sessions for the purpose of educating and training physicians, non-physician providers, and other staff
• Identify additional opportunities to improve education of physicians, non-physician providers and staff
• Working with the billing and coding departments, prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels
• Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff
• Based on types of questions/issues received, identify education/awareness opportunities and guidance topics
Requirements:
• Experience with using and navigating through an electronic medical record system
• Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required
• Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required
• Ability to think abstractly and concretely required
• Ability to develop reports, presentations, and spreadsheets required
• Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access, and Internet Explorer is required
• Outstanding verbal and written communication skills is required
• Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required
• Ability to gain the trust and confidence of the providers, compliance team and billing staff
Benefits:
• Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans
• HSA / FSA
• 401(k) matching
• an Employee Assistance Program (EAP) and more