Compliance Auditor

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Compliance Auditor plans, schedules, and performs comprehensive internal professional fee audits to include routine and focused audits. Performs detection of documentation, coding, and billing errors as well as collaboration with appropriate stakeholders to ensure correction and/or appropriate response to identified issues. Communicates audit results to providers, coders, management, and other appropriate staff. Develops and delivers provider and coder education. Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to regulatory compliance with guidelines related to professional fee documentation, coding, and billing. Stays abreast of documentation, coding, and billing regulations and standards and serves as a subject matter expert on interpretation and application of documentation and coding rules and regulations.

Responsibilities:
1. Plans, schedules, and performs comprehensive internal professional and hospital fee audits as determined by the Compliance & Privacy Office Work Plan to include routine and focused audits. Detection of documentation, coding, and billing errors as well as collaboration with appropriate stakeholders to ensure correction and/or appropriate response to identified issues. 

2. Communicates audit results to providers, coders, management, and other appropriate staff and makes recommendations to ensure sustained improvement. 

3. Develops and delivers provider and coder education. 50% 

4. Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to regulatory compliance with guidelines related to professional and hospital fee documentation, coding, and billing, including federal and state regulations, CMS, and OIG compliance standards. 

5. Stays abreast of ever-changing documentation, coding, and billing regulations and standards. Serves as subject matter expert on interpretation and application of documentation and coding rules and regulations.

Job Specifications 

Education: Associate’s/bachelor’s degree preferred or high school diploma with requisite experience 

Licensure: n/a 

Experience: 

Must have 5 years' experience as a coder in a hospital or clinic environment. Prefer 3 years auditing experience in a hospital or clinic environment, as well as familiarity with hybrid and split billing. Prefer experience with Epic as the electronic medical record. Extensive knowledge of evaluation and management coding, modifiers, provider-based billing, and auditing principles are required. Knowledge of federal, state, and private payor guidelines and internal billing guidelines/procedures. Ability to provide feedback to medical providers, coders, and managers in a constructive way to promote learning and collaboration. Strong verbal and written communication skills. Effective time management skills. Proficient with web tools and Microsoft Office. Ability to develop and deliver education to various stakeholder audiences. Must be able to maintain the highest level of confidentiality of sensitive information CERTIFICATION Must posses an AAPC coding certification (such as CPC) and specialty certification preferred. Must have auditing certification of CPMA or other accredited auditing certification, or ability to obtain such certification within 12 months of hire date  

Other Information

Other information:
1545
01.9593.1545

Job Details

Legal Employer: Pardee - HCHC

Entity: Pardee UNC Health Care

Organization Unit: Compliance

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Hendersonville

Exempt From Overtime: Exempt: Yes

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.