Medical Group Compliance Auditor Senior - HYBRID
Medical Group Compliance Auditor Senior - HYBRID
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
The Medical Group Compliance Auditor Senior is responsible for providing audit coding support and guidance to physicians APPs residents and support staff. This role ensures that all coding billing and documentation complies with federal and/or state regulations private payer health care program requirements as well as the Compliance and Operations Policies of the organization. This job assists with the development and implementation of educational and training programs as well as coding tools and resources to help achieve organizations goal of consistent complete and accurate coding and documentation.
Responsibilities
Capable of working independently to conduct regularly scheduled compliance reviews for assigned providers practices and focused review areas within designated time frames.
Provides mentorship and guidance to the more junior Medical Group Compliance Auditor during the audit completion process.
Performs Reviews clinical documentation to verify accuracy of CPT/HCPSC and ICD.10 codes and modifier assignments.
Provides written report of findings to the provider and select administrative personnel along with recommendations for improvement.
Monitors regulatory and reimbursement information to keep informed of relevant changes and updates.
Performs special demand audits as requested or noted in compliance or audit work plans program.
Educates providers one-on-one or in a group setting based on need or as a result of an audit.
Provides oversight and quality assessment of audit and other work of Medical Group Compliance Auditors as well as peers.
Maintains effective communication with department staff as well as key stakeholders and consistently demonstrates high standards of professional conduct and ethics as well as appropriate judgment independence and discretion.
Performs other duties as assigned.
Qualifications
EDUCATION:
Required: Bachelors Degree required; or Associates Degree required with 5 years of auditing experience.
EXPERIENCE:
Required: 5 years of professional coding experience with a minimum of two years auditing experience for coding compliance/accuracy with Bachelors Degree
LICENSURE/CERTIFICATION/REGISTRY/LISTING:
Preferred: Any additional certifications such as Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA).
Required Experience:
Senior IC
Employment Type
Full-Time
