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Compliance Auditor
Universal Health Services
Location: King of Prussia, Pennsylvania
Work Setting: Hospital
Job Function: Compliance
Job Type: Full-Time
Introduction
Job Description
Key Responsibilities include:
- Complete internal compliance coding and charging audits to compliment targeted reviews and results from various outside reviewers. Offers guidance for the ongoing coding and charge practice methodologies across the acute care hospitals, including inpatient and outpatient area focuses
- Based on new requirements, audits findings, RACs, MACs, etc. prioritize and develop training/education protocols for UHS hospitals in ICD-9-CM, CPT-4, APC’s, Emergency Room Evaluation and Management, coding guidelines, modifier guidelines, and proper diagnosis and procedure code selection
- Review and assess charge capture methodologies and the documentation of orders and clinical documentation to support charges. Review department charge sheets and charge entry modalities within ancillary systems. Identify areas of opportunity and monitor compliance with internal and regulatory standards related to charging, providing feedback and education to facility staff as needed
- Investigate and resolve related issues in conjunction with the Charge Master Specialists including assessment of appropriate modifiers, accuracy of DRG assignment, completeness of coding, CCI and OCE edits, medical necessity, billing questions, denials, and charge reconciliation issues
- Assist in preparation of policies related to compliance in coding and charging
Required Qualifications
- RHIA or RHIT or Coding Certification (CCS) through AHIMA, CPC credentials a plus
- Proficient in current Coding and Charging Practices, including UHDDS, AHIMA, CMS and other governmental regulations and guidelines
- Proficient in chart review, coding methodologies with the ability to understand hospital claims, chargemaster, and regulatory and payer communications and payment methodologies
- Knowledge and experience using EMRs, medical necessity software, charge master systems and Microsoft Office
- Travel up to 25%
Compensation/Benefits
Apply Online: https://jobs.uhsinc.com/corporate/jobs/68507?lang=en-us
Posted: January 25, 2021 at 3:36 PM
Post ID: 57759