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Compliance Auditor Job

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Date: Nov 10, 2021

Location: Memphis, TN, US

Company: Methodist Le Bonheur Healthcare

Summary

Conducts auditing and monitoring as set forth in the annual compliance audit plan including making recommendations of corrective action plan and audit follow-up. Serves as a subject matter expert for a variety of coding and billing related compliance issues. Coordinates, assists and conducts internal investigations related to coding and documentation issues as directed by the Compliance Manager. Models appropriate behavior as exemplified in The Methodist Mission, Vision and Values.

Education/Experience/Licensure

 

Education/Formal Training

Work Experience

Credential/Licensure

REQUIRED:

Associate’s degree in Health Information Management, Healthcare Administration, Business, Finance or related field.

Minimum of (3) years of clinical coding and compliance experience in a healthcare setting

Must have one of the following certifications:

American Health Information Management Association (AHIMA)

Certified Coding Specialist (CCS)

Certified Coding Specialist-Physician based (CCS-P)

Registered Health Information Administrator (RHIA)

Registered Health Information Technician (RHIT)

American Academy of Professional Coders (AAPC)

Certified Professional Coder (CPC)

Certified Outpatient Coder (COC)

PREFERRED:

Bachelor’s degree in Health Information Management, Healthcare Administration, Business, Finance or related field

N/A

N/A

SUBSTITUTIONS ALLOWED:

In lieu of an Associate’s degree, the candidate must have a High school diploma with five years of clinical coding and compliance experience in a healthcare setting

N/A

N/A

 

Knowledge/Skills/Abilities

  • Knowledge of Medicare and Medicaid documentation and coding rules and guidelines.
  • Must have an understanding or develop knowledge of national and state laws and regulations including but not limited to:
    • False Claims Act
    • Physician Self-Referral (Stark) Anti-kickback statute
    • Health Insurance Portability Act (HIPPA)
    • Health Information Technology for Economic and Clinical Health (HITECH)
  • Must have excellent verbal and written communication skills.
  • Strong interpersonal skills and evidence of previous success in dealing with staff at all levels, including nurses, non-physician practitioners, physicians, and management.
  • Strong organizational and planning skills.
  • Demonstrates a high degree of personal integrity and practice ethical standards.
  • Demonstrates proactiveness and ability to work independently and self-directed in managing multiple concurrent projects.
  • Excellent analytical and problem solving skills.
  • Advanced skills in all MS Office applications (Word, Excel, Outlook, and PowerPoint). 
  • Ability to interpret and apply documentation and coding rules and regulations.
  • Ability to demonstrate competence in performing audits, produce reports, formulate remediation or mitigation plans, and conduct follow-up audits.

Key Job Responsibilities

  • Performs compliance auditing and monitoring pursuant to the annual compliance audit plan.
  • Reviews coding and billing practices to ensure compliance with regulatory requirements. Analyzes findings and makes recommendations for corrective action plans.
  • Monitors implementation of corrective action plans and performs audit follow up to verify correction and compliance.
  • Assists and makes recommendations to updating annual audit plan.
  • Assists with education and training of providers and associates regarding coding and billing practices.

Physical Requirements

  • The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
  • Must have good balance and coordination.
  • The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
  • The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
  • The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.


Nearest Major Market: Memphis

Job Segment: Audit, Compliance, Claims, Law, Medicaid, Finance, Legal, Insurance, Healthcare