Senior Compliance Auditor
Overview:
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Description:
Reporting to the Director, Compliance Audit and Analysis, the Sr. Compliance Auditor will develop and execute audit, monitoring, and education for both facility and professional billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluate facility/professional billing compliance activities to assess compliance with the Compliance Audit and Analysis Program Work Plan and appropriately focuses on risk areas. Serve as a resource for providers and other clinicians on facility/physician billing and coding. This individual will:
- Prepare and oversees facility/professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
- Lead focused audits and reviews to investigate adherence with facility/professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
- Assist in development of organizational compliance auditing and monitoring activities for facility/professional billing and coding, including periodic reviews of the individual department auditing and monitoring functions.
- Coordinate sample reviews to ensure codes that were billed are properly supported by appropriate documentation and creates audit result reports to be reviewed with providers and hospital departments.
- Serve as primary lead for facility/professional billing compliance education including auditing, trending, and feedback to facility/professional coders and providers working in the hospital and office setting, as applicable.
- Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers and leads training on proper documentation for facility/professional billing and coding compliance.
- Work with the compliance operations, billing team, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.
- Provide counseling, education and/or recommended disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to facility/professional billing compliance.
MINIMUM REQUIREMENTS:
- Bachelors degree required Certification: Current Certified Coding Specialist (CCS) or Certified Professional Coder certification required.
- Minimum of five to seven (5-7) years of experience with facility and/or professional audit activities, required.
- Proficient in MDAudit Enterprise software and Epic electronic health record systems.
- Thorough knowledge of coding documentation improvement practices.
- Thorough knowledge and understanding of hospital inpatient billing, coding, and documentation requirements, Federal and State regulations, medical necessity, clinical best practices, and facility/professional billing issues.
The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.
Additional Details:
Supporting a diverse, equitable and inclusive culture. Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status.EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.
Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.
PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally); 11-25 lbs., 34-66% of the workday (frequently); 01-10 lbs., 67-100% of the workday (constantly); Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.
ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required.Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.