Compliance Auditor & Educator

Job Description

SUMMARY:

Under direction of the Director of Coding and Compliance, the Compliance Auditor and Educator will participate in the performance of medical record audits of all College of Medicine Departments involved with billing third-party payers.  Will also serve as an educator for physicians, residents, and billing/coding staff regarding coding and documentation requirements.  

ESSENTIAL DUTIES AND RESPONSIBILITIES:

*Include the following. Other duties may be assigned.*

• Perform annual audits of documentation of inpatient and office medical records by physicians, residents, nurse practitioners and other providers.
• Educate the physicians, residents, nurse practitioners and other providers of coding and documentation issues based on the audits.
• Report audit results to the Associate Dean, Compliance Committee, and Board of Directors as appropriate.
• Provide coding and documentation guidelines to the physicians, residents, nurse practitioners, and billing employees as needed.
• Provide an orientation to all new hire physicians on the compliance plan and policies, teaching physician guidelines.
• Research problem areas and provide solutions related to coding and payer requirements.

EDUCATION AND/OR EXPERIENCE:

Knowledge of CPT, ICD-10-CM and HCPCS coding systems and guidelines.  Basic knowledge of HIPAA guidelines necessary.  Experience in an academic and/or multi-specialty environment.  Knowledge of medical terminology, physician billing, third-party regulations and auditing procedures.  High school diploma or GED required.  CPC or CCS required, plus 3 years of coding and billing experience.  CPMA is preferred; this certification would be required to obtain within 6 months of employment. Bachelor’s degree and/or previous auditing experience preferred but not required. 

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EOE/AA/M/F/Disability/Vet

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