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~SENIOR COMPLIANCE AUDITOR
Senior Compliance Auditor
Required Qualifications
- Coding certification required (RHIT, RHIA, or CCS-P preferred)
- Previous E&M, CPT and ICD-9-CM coding and auditing experience is required
- Previous experience in creating topic specific formal education sessions is required
- Previous experience in presenting formal education sessions to physicians and professional staff is required
- Expert level working knowledge of complex billing and documentation regulations and the ability to research additional topics when necessary
- Familiarity with Medicare and Medicaid regulations
- Proficient in Excel, PowerPoint, and MS Word
Job Components
- Monitor the Medical Center's compliance with governmental regulations through the performance of planned and unplanned compliance audits
- Design and perform audits to test appropriateness of billing, coding, and documentation. Audits are primarily provider focused and encompass both E&M and procedural billing.
- Design and perform investigations of potential non-compliance with governmental regulations
- Draft reports of audit findings and maintain detailed audit workpapers
- Aid in the development of corrective action plans for audited departments
- Communicate audit findings and required corrective actions to audited departments
- Conduct education sessions where necessary; education sessions vary from a large group audience to personalized sessions with individual providers
- Perform follow-up procedures and testing to assess implementation of corrective action
- Maintain an understanding of regulatory issues and updates through seminars, training courses and regulatory literature
- As needed, serve as the internal liaison for applicable audits/projects conducted by external consultants
Job Standards/Expectations
- Apply audit knowledge in different multidisciplinary situations to produce correct audit findings using AHIMA, CPT, and CMS guidelines
- Develop clear and concise audit reports
- Maintain independence, objectivity and professional skepticism
- Demonstrate desire to continuously improve audit and coding skills through professional development efforts
- Complete work in an efficient manner
- Prepare detailed and organized work papers to support audit conclusions
- Demonstrate ability to work independently and creatively
- Interact professionally with all levels of employees
- Show ability to recognize fraud "red flags" and to develop tests to identify fraud or non-compliance with regulations
- Uphold Rush's mission and values