System Compliance Auditor

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

📋 Description

• Identify and evaluate risks within documentation, coding, and billing processes.

• Assist in mitigating potential fines and penalties from governmental agencies.

• Design and deliver orientation training for new providers.

• Conduct annual audits of provider billing practices.

• Provide continuous education to providers and employees engaged in preparing or submitting professional bills to federal payers.

• Communicate audit findings to billing providers, administrative and clinical leaders, and non-clinical staff.

• Offer recommendations based on the findings from audits.

• Collaborate with professional and hospital billing departments, Coding Education, Health Information Management, Revenue Integrity, management, and physician leaders.

• Identify risk areas related to billing and perform audits accordingly.

• Suggest measures to mitigate risks and enhance compliance.

• Assist in the creation of the annual Compliance Audit Work Plan.

• Ensure organizational policies and audit standards align with relevant requirements.

• Stay updated on applicable state and federal regulations.

⛳️ Requirements

• A Bachelor's degree in business, health care operations, or a clinical field is required; significant work-related auditing experience with academic credentials may be considered as a substitute.

• A Master's degree in business or a health care-related field is preferred.

• Certification from the American Academy of Professional Coders (AAPC) is mandatory.

• CPC-E/M Auditor certification is preferred.

• A minimum of five years of relevant experience in coding and billing for professional services.

• At least one year of auditing experience is required.

• Familiarity with applicable state and federal regulations concerning documentation, coding, and billing.

• Capable of conducting audits, recognizing billing-related risk areas, and recommending strategies to reduce risks and promote compliance.

🏝️ Benefits

• Full-time employment.

• Standard work hours: 40.

• Day shift schedule.

• No weekend work required.