Compliance Billing & Coding Auditor II

This is a fully remote position, open to applicants in California.

📋 Description

• Initiate and conduct proactive coding and billing audits prior to claims submission, with retrospective audits as needed.

• Utilize auditing software and tools to enhance audits and improve data analysis processes.

• Monitor and review billing and coding data for errors and compliance with regulations.

• Assess ICD, HCPCS, CPT, E&M, APC, DRG assignments, charges, medical necessity, and reimbursement accuracy.

• Examine documentation supporting billed services and perform compliance risk assessments.

• Investigate issues related to billing and coding compliance, including independent audits of facility and professional fee accounts.

• Collaborate with various departments to collect information and assess documentation.

• Prepare audit and investigative reports detailing findings and recommendations for corrective actions.

• Oversee the implementation and evaluate the effectiveness of corrective measures.

• Provide feedback to Billing and Coding educators and assist in the development of training materials.

• Stay updated on federal, state, payer, healthcare regulations, and coding guidelines.

• Assist educators in addressing compliance inquiries.

• Contribute to the Office of Compliance and Privacy’s Risk Assessment, Workplan, and strategic objectives.

⛳️ Requirements

• Associate’s degree in a relevant discipline from an accredited college or university, or a comparable combination of education and experience.

• A minimum of four (4) years of progressively responsible, directly related work experience.

• Experience with EPIC EHR is preferred.

• Ability to manage, organize, prioritize, multitask, and adapt to shifting priorities.

• Strong written and verbal communication skills, including the ability to summarize data and present findings.

• Capability to lead problem identification and resolution efforts.

• Proficient in supporting arguments with data and applying critical thinking skills.

• Aptitude for mediating and resolving complex work-related issues.

• Ability to facilitate work groups toward successful outcomes.

• Knowledge of ICD-10-CM/PCS, HCPCS, E&M, and CPT coding conventions.

• Familiarity with DRG/APC reimbursement and third-party payer policies and regulations.

• Understanding of healthcare compliance audit requirements, principles, and methodologies.

• Competence in conducting healthcare corporate compliance functions and audits, along with preparing findings reports.

• Uphold high standards of professional ethics, integrity, and trust.

• Ability to maintain the confidentiality of sensitive information.

• Current knowledge of healthcare compliance requirements, practices, and trends.

• Proficient in using EPIC and 3M computer systems.

• Skilled in Microsoft Word, Excel, and PowerPoint.

• CCS, CCS-P, CPC, CIC, or COC certification must be obtained within 180 days.

• CHC certification is preferred.

• Experience in hospital and/or professional auditing within an Academic Medical Center is preferred.

• Candidates are expected to adopt and uphold Stanford Health Care’s C-I-CARE standards.

🏝️ Benefits

• Remote work arrangement.

• Base pay ranging from $52.69 to $69.82 per hour.

• Opportunities to engage in compliance training sessions and workshops.

• Chance to contribute to the strategic objectives of the Office of Compliance and Privacy.