Senior Compliance Auditor

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

📋 Description

• Oversee and execute ongoing audits on a scheduled, as-needed, or requested basis, with an emphasis on anesthesia documentation, billing, and coding compliance.

• Assess clinical documentation to ensure adherence to coding, documentation, and billing laws, regulations, and guidelines.

• Assist in audit planning, pinpoint potential risk areas, and relay findings to compliance leadership.

• Analyze medical records to evaluate documentation, coding, and charge accuracy, as well as identify discrepancies.

• Prepare, analyze, and deliver audit reports.

• Create and implement targeted communications, training sessions, and educational programs for healthcare providers.

• Inform compliance leadership about documentation, coding, and charge errors and trends.

• Aid in the development of corrective action plans and coordinate the resolution of audit findings and emerging risks.

• Facilitate the onboarding and training of new compliance auditors; mentor junior auditors and provide subject-matter expertise.

• Prepare for external audits, manage information requests, and track deliverables.

• Organize audit schedules and keep accurate records of audit activities.

• Offer guidance on documentation, coding, claim review, and billing inquiries; stay updated on relevant laws, regulations, payer bulletins, periodicals, and websites.

• Define audits, formulate action plans, document findings, draft reports, and communicate results to compliance leadership and/or the Compliance Committee.

• Engage in educational programs, training sessions, meetings, and special projects.

• Uphold strict confidentiality of patient records and audit reports.

• Carry out other duties as assigned or requested.

⛳️ Requirements

• A high school diploma or equivalent is mandatory; an associate or bachelor’s degree in a related field is preferred.

• A minimum of 7 years of anesthesia coding experience or an equivalent combination of education and coding experience is required.

• Prior auditing experience is necessary.

• Certification in medical coding (Certified Professional Coder or Certified Coding Specialist) is required.

• Advanced certification as a Certified Anesthesia and Pain Management Coder (CANPC) is preferred.

• Certification as a Certified Professional Medical Auditor (CPMA) or Certified Healthcare Auditor (CHA) is preferred.

• In-depth knowledge of CPT, ASA, and ICD-10 coding is essential.

• Familiarity with managed care, Medicare, Medicaid, and workers’ compensation billing and coding regulations and guidelines specific to anesthesia is required.

• Expert understanding of auditing methodologies and compliance frameworks is crucial.

• Excellent written and verbal communication skills, including high-level report writing, are necessary.

• Outstanding critical thinking, problem-solving, and data analysis capabilities are essential.

• Advanced research skills are required.

• Strong time management, prioritization, and organizational abilities are necessary.

• Capacity to independently investigate, analyze, and resolve complex or non-routine issues is important.

• Proven capability to lead projects, mentor staff, collaborate with diverse departments, and communicate effectively with staff, providers, leadership, and stakeholders is essential.

• Proficiency in computers and word-processing, spreadsheet, and database programs is required.

• High attention to detail and accuracy is crucial.

• A professional demeanor and the ability to work efficiently in cross-functional environments are necessary.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with employer matching.

• Paid time off and flexible work arrangements.

• Continuing education and professional development opportunities.