The Compliance Medical Auditor performs audits and monitoring of clinical documentation analyzing medical records assessing the accuracy of ICD-10-CM/PCS, CPT or HCPCS codes; determining compliance with appropriate policies, procedures, and regulations. Identifies and recommends strategies for process improvement. Prepares written reports on findings. Maintains an up-to-date working knowledge on regulatory requirements associated with outpatient and procedure area coding and billing and claims processing. The incumbent will participate in all aspects of the organization’s Compliance Program.
Essential Duties and Responsibilities:
Supervisory Responsibilities: None
Education and/or Experience:
Bachelor’s degree required.
Certificates, Licenses, Registrations:
Certification in Health Care Compliance or Graduate Certificate in Health Care Compliance preferred as well as one of the following coding certifications through American Health Information Management Association or the American Academy Professional Coders: Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), Certified Professional Medical Coder (CPC), or Professional Medical Coder Outpatient Hospital (COC).
Proficiency using a Windows computer platform
Experience with electronic medical record and billing platforms
Ability to learn new systems quickly
Environmental Factors/Physical Demands:
Work is performed in an office environment with some travel required in this position. While performing the duties of this job, the employee is regularly required to drive. Must have the ability to maintain active customer communication; access, input and retrieve information for the computer system, enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to sitting for long periods of time, bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.