This position is responsible for auditing the accuracy of assigned diagnostic and procedure codes to records of patients; ensuring compliance with federal, state and regulatory requirements and USAP policies and procedures; providing accurate, meaningful and timely audit reports and findings to management. This position is also responsible for communicating with management, and providers regarding audit results, new or revised documentation guidelines and other compliance related information as required.
1. Assist Chief Compliance Officer and Director of Compliance in audit planning activities.
2. Prepare accounts and medical records for review and analyze charges for variances and appropriateness.
3. Conduct continuous audits based on a pre-determined schedule as well as on an as needed or requested basis for Demographics, Billing, Coding and medical record documentation for Anesthesia and Pain Management according to defined criteria.
4. Assist with the development and presentation of communications, training and educational programs for providers resulting from provider audit findings, including billing, coding and medical record documentation.
5. Develop and present informational communications related to follow up compliance training and education.
6. Communicate documentation, coding, and charge errors and trends found in audits to the Director of Compliance and Chief Compliance Officer.
7. At the direction of the Chief Compliance Officer or Director of Compliance, communicate with audit consultants to explain charge methods, perform audits and verify data as needed.
8. Assist with preparation for external audits and coordinate information requests. Track deliverables by the external auditors to facilitate timely completion of external audits.
9. Keep up to date on current laws, regulations and guidances applicable to Anesthesia and Pain Management coding, billing and medical documentation.
10. Participate in educational programs and in-service meetings; attend other meetings as requested and/or required.
11. Assist with special projects as directed.
12. Maintain strictest confidentiality.
13. Perform other duties as assigned/requested.