COMPLIANCE AUDITOR - PROF SVCSApply Job ID 47384 Job Type Full Time Shift Day
The auditor reviews professional fee billing, coding and documentation. Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses. Customers include employed providers, senior leadership, clinical and non-clinical staff of Cooper University Health Care.
Under the supervision of the Chief Compliance Officer, auditors are responsible for supporting the corporate compliance program, responsibilities include:
• Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures
Preparatory work for reviews/audits including developing a scope of work;
Reviewing available documentation;
Analyze/review audit data and prepare reports for review and presentation to management, providers and departments, making recommendations for improvement
Determine charge corrections and refunds resulting from compliance reviews and ensure they have been completed
Post-review/audit education/training when applicable;
Performing follow-up reviews when necessary;
Ensuring appropriate work papers, either paper or electronic, are maintained in accordance with regulations/policy
• Assist in the development of policies and procedures that establish standards for compliance, as well as preparation of other guidance documents and tools to assist Coper providers and staff in appropriate billing, coding and documentation;
• Serve as liaison for questions, concerns, incidents and complaints regarding compliance matters, responding directly to the inquiry and/or consulting or interacting with other team members or departments. Inform Chief Compliance Officer of major findings; based on types of questions/concerns received, recommend remedial correction and prevention actions; identify education/awareness opportunities and guidance topics
• Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes
Scheduled Days / Hours: weekdays
Education: . Current certification as a CPC, CCS-P or comparable credential; four (4) year college degree preferred
Experience: 3+ years’ experience in an academic medical center preferred, with emphasis on provider compliance activities, including but not limited to: auditing, monitoring, investigation and training
Demonstrated knowledge and understanding of provider professional fee billing, coding and documentation practices in inpatient and outpatient settings.
Demonstrated expertise in medical terminology.
Demonstrated expertise in healthcare coding (CPT, ICD-9, ICD-10, APC, HCPCS).
Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information (PHI).
Demonstrated knowledge and understanding of federal and state statutes, laws, rules and regulations affecting billing, coding and documentation practices in support of healthcare services provided to beneficiaries of federally-funded healthcare programs and other third party payers.
Demonstrated knowledge and understanding of the essential elements of an effective compliance program
Working knowledge and understanding of:
- provider professional fee revenue cycle and reimbursement;
- electronic billing and medical record systems
- sampling technologies and statistical analyses
.Experience using personal computers required.
Experience using the following applications is desirable: Word, Excel, e-mail, and healthcare related billing systems.
Experience using MDAudit audit software and/or EPIC EMR desirable
Required License/Certifications/ Registration: Current CPC. CCS-P or comparable credential required.
Valid driver’s license and automobile insurance per company policy
Other Qualifications: Excellent oral and written communication skills
Excellent organizational and analytical skills
Excellent attention to details
Conflict resolution skills
Ability to work with minimal supervision and exercise a great deal of discretion and judgment
Ability to travel to off-site locations