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Compliance Auditor

Compliance Auditor

Job ID 
2017-1744
Location 
US-TX-Dallas
Function 
Legal/Compliance
Employment Status 
Full-Time

More information about this job

Overview

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.

Responsibilities

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.

Qualifications

JOB REQUIREMENTS:

  • Knowledge of CPT, ASA, and ICD-10 codes, and Managed Care, Medicare, Medicaid and Workers Comp. billing and coding rules, regulations and guidances.
  • Advanced knowledge of Anesthesia and Pain Management billing requirements and processes.
  • The ability to recognize what needs to be done and initiate activities without direction, the ability to provide clear and accurate direction and to train providers and billing and coding staff.
  • Efficiency in time management, setting priorities and meeting deadlines. The ability to work on multiple projects and establish appropriate priorities.
  • Excellent written and verbal communication skills.
  • Skill in gathering, researching and reporting information.
  • The ability to maintain confidential and sensitive information.
  • The ability to investigate, analyze and resolve non-routine issues and problems.
  • Ability to work effectively and independently with staff, providers, department management, and external customers in a pleasant, courteous and organized manner.
  • Working knowledge of computers and ability to use word-processing, spreadsheet and data base programs.
  • Strong attention to accuracy and detail.
  • Effective organizational skills and attention to detail; effective follow-through commitment to excellence.
  • Self motivated; ability to work without direct supervision.
  • Must have a pleasant disposition and high tolerance level for diverse personalities.

EDUCATION/TRAINING/EXPERIENCE:

  • High School diploma or equivalent is required, associate’s or bachelors’ degree in related field preferred.
  • 2 to 3 years Anesthesia and Pain billing/coding experience; or equivalent combination of education and experience.
  • Previous auditing experience, preferred
  • Certification in coding required (Certified Professional Coder, Certified Coding Specialist)
  • Advanced certification as Certified Anesthesia and Pain Management Coder (CANPC), preferred
  • Certified Professional Medical Auditor (CPMA), or Certified Healthcare Auditor (CHA), preferred

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