Compliance Auditor
$68,000–$120,500 year
RemoteConnecticut, United States
Job Summary
Coordinate and conduct medical billing audits for 18 clinical departments, evaluating documentation for ICD-10 and CPT-4 coding accuracy and compliance with university and government regulations. Obtain and review charge documents, encounter forms, and medical records to assess provider documentation, then identify system control weaknesses. Develop corrective action plans with department management, implement changes, and maintain accurate tracking logs of all investigations. Follow up on corrective actions, report findings to the Compliance Officer and University Auditor, and conduct training sessions with physicians on billing compliance. Generate reports using Query tools to identify trends and problem areas, while staying abreast of regulatory changes and best practices.
Required Qualifications
- CPC required
- Demonstrated knowledge of ICD-10 and CPT-4 coding and billing practices
- Ability to interpret operative and procedural reports
- Well-developed oral and written communication skills
- Strong attention to detail with the ability to analyze data
- Proficient in Microsoft Word, Excel, and Access
- Bachelor's in Health Care Management, Finance, Business or Nursing or a related field
- Five years' experience in multi-specialty group practice, academic plan or hospital or an equivalent combination of educational and experience
- Must be able to lift 50 lbs
Desired Qualifications
- CPC credentials preferred
- Computer skills including Epic, WEBI, Word, Excel, and Access
- Proven experience in healthcare auditing, Medicare and Medicaid, or related clinical field
- Knowledge of University Medical Billing Compliance Plan, operations and procedures
- Stay abreast of best practice coding and auditing practices and regulatory changes
- Maintain CPC designation by obtaining necessary CEUs on an annual basis
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