Compliance Auditor
Compliance Auditor
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$ 30 - 31
1 Vacancy
Job Description
Job Details
Description
At DAP Health we are committed to transforming lives and advancing health equity for all. As a leading nonprofit health care provider we deliver compassionate high-quality care to the diverse communities of the Coachella Valley and San Diego County. Our comprehensive services range from primary care to mental health wellness programs and beyond with a focus on those who are most vulnerable. Joining our team means becoming part of a passionate innovative organization dedicated to making a meaningful impact in the lives of those we serve. If youre looking for a dynamic and purpose-driven environment we invite you to explore the opportunity to contribute to our mission.
Job Summary
As a Compliance Auditor you will work remotely to determine the accuracy of ICD-10 Codes forprocedures and diagnoses on outpatient claims. You will ensure that all coding assignments are accurateaccording to coding policies and based on the documentation provided in the medical record. Using a
thorough knowledge of coding policies and procedures and medical terminology and technology youwill provide documentation feedback to physicians. You will be challenged with daily production goalsand high-level oversight of work production of the broader compliance audit this role you will
also be a key coding resource and provide coding expertise and guidance to broader compliance auditteam billing department and physicians.
Supervisory Responsibilities: None
Essential Duties/Responsibilities
- Conduct compliance coding reviews of medical records and supporting documentation againstsubmitted claims to determine coding and billing accuracy for medical dental and mentalhealth services
- Research and interpret coding guidelines and internal coding policies and procedures to verifyclaim coding accuracy
- Observe and report opportunities for documentation improvement
- Identify documentation trends and topics for education/feedback
- Participate in additional compliance audits and/or tasks as assigned
Qualifications
Required Skills/Abilities
- Excellent oral and written communication skills
- Effective interpersonal skills
- Computer proficiency including programs such as MS Office Word Excel email andinternet research
- Ability to navigate clinical information systems for accessing health information in anelectronic environment
- Ability to educate and train Compliance and Clinical standards to staff members
- Ability to effectively elicit/provide information to and from appropriate individuals (includingsupervisors co-workers patients) via effective communication skills
Education and Experience
- One (1) to three (3) years of experience in medical billing and coding in outpatient andambulatory care settings
- College level courses in anatomy physiology and medical terminology
- Demonstrated knowledge of CPT ICD-10 and HHC coding
- Background in medical billing coding or auditing of insurance claims and medical records
- Demonstrated understanding of payer rules and regulations including Medicare and Medicaid
- Demonstrated knowledge of clinical compliance best practices medical record review legalaspects of documentation etc.
- Previous FQHC experience with 340B Grants and Clinical operations and Federal and Stateregulations preferred
- Medical Coding Certification from AHIMA and/ or AAPC (CCS RHIA RHIT CIC ROCC CPC COCCPC-P CRC CPMA CPDS) to be maintained annually
Working Conditions/Physical Requirements
- This job operates in an office setting and requires frequent times of sitting standing repetitivemotion and talking
- This is a virtual remote position that requires candidates to be highly organized self-startersand well-versed in technical applications. Previous success in a remote environment ispreferred. This position is full-time (40 hours per week) Monday - Friday. Employees arerequired to work our normal business hours of 8:00 AM - 5:00 PM. It may be necessary giventhe business need to work occasional overtime including weekends
- Occasional travel to California may be required
- Ability to lift up to 40 pounds and move from place to place
- Ensures compliance with policies and procedures related to safe work practices
Employment Type
Full-Time
