Compliance Billing & Coding Auditor II

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

📋 Description

• Initiate and conduct proactive coding and billing audits prior to claims submission, as well as perform retrospective audits when necessary.

• Utilize auditing software and tools to enhance the auditing process and improve data analysis.

• Monitor and assess billing and coding data for inaccuracies and ensure compliance with regulations.

• Evaluate medical services and verify the accuracy of ICD, HCPCS, CPT, E&M, APC, DRG assignments, and associated charges.

• Review documentation that supports billed services and identify compliance risks through comprehensive risk assessments.

• Conduct investigations and independent audits of facility and professional fee accounts for all patient categories.

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

• Prepare audit and investigation reports detailing findings, recommendations for corrective actions, and areas for improvement.

• Monitor the implementation and effectiveness of corrective measures.

• Provide feedback to Billing and Coding educators to enhance training materials.

• Stay informed on federal, state, payer, healthcare regulations, and updates to coding guidelines.

• Engage in compliance training and assist in the creation of training content for revenue cycle departments.

• Support educators in addressing compliance inquiries.

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

⛳️ Requirements

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

• A minimum of four (4) years of progressively responsible work experience in a related field is required.

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

• Experience with EPIC EHR is preferred.

• Familiarity with ICD-10-CM/PCS, HCPCS, E&M, CPT, DRG/APC reimbursement, and third-party payer regulations.

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

• Capability to plan, organize, and execute detailed healthcare corporate compliance functions and audits.

• Ability to identify waste, fraud, abuse, and inefficiencies in accordance with laws, regulations, and standards.

• Competence in making independent decisions, drawing logical conclusions, and preparing reports with findings and recommendations.

• Knowledge of computer systems, specifically EPIC and 3M.

• Proficient in Microsoft Word, Excel, and PowerPoint.

• Ability to manage priorities, multitask, adapt to changing circumstances, communicate effectively, summarize data, and present outcomes.

• Skill in providing leadership in identifying problems and resolving issues.

• Ability to apply critical thinking, mediate disputes, and solve complex work-related challenges.

• Capability to facilitate work groups towards successful outcomes.

• Ability to maintain confidentiality while staying current with healthcare compliance requirements, practices, and trends.

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

🏝️ Benefits

• Remote work arrangement.

• Full-time employment.

• Day shift with an 08-hour schedule.

• Opportunities for professional development through compliance training sessions and workshops.

• Involvement in the development of compliance training content.

• Commitment to equal opportunity employment.