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Compliance/Coding Auditor Educator
Location: Louisville, Kentucky
Work Setting: Hospital
Job Function: Compliance
Job Type: Full-Time
Responsible for ensuring that all professional services billing audits and projects identified on the schedule established by the Internal Audit Manager are managed within the expected timelines, priorities are appropriately adjusted for unplanned reviews, and post-audit education meetings are conducted with each individual provider to share findings. Individualized post-audit meetings should be conducted within timeframes specified in Audit Program policies and procedures.
Conducts internal compliance audits of medical documentation, coding and supporting claims that are billed to third parties to ensure compliance with applicable coding and billing regulations. Prepares detailed reports for the Internal Audit Manager to include audit results and recommendations for improvement.
Ensures that the educational needs surrounding documentation compliance of each billing professional is met through effective identification of compliance issues, new provider orientation, and that the organization provides the appropriate training opportunities to resolve issues. Provides ongoing training to providers to ensure their documentation supports the level and acuity of services billed.
Available to physicians, APCs, management, and staff for questions related to coding (e.g. surgical procedures, modifiers, documentation requirements). Solicits clarification from physician or provider regarding ambiguous or conflicting documentation.
Works collaboratively with Internal Audit Manager to investigate complex coding compliance concerns, research coding and/or documentation questions, and provide education to physicians, APCs, and/or staff as requested.
Available upon request to personally perform special (non-routine) audits and share findings as directed. Provides post-review analysis and training.
Responsible for billing and coding compliance investigations originating from internal or external sources, compiling supporting documentation for results and proposed action plans to address potential areas of improvement and/or non-compliance.
Manages prospective and/or retrospective inpatient and outpatient professional and/or technical documentation audits of professional and/or technical component billing. May analyze or validate routine chart audits performed for multiple specialties.
Promotes effective compliance communication, use of the Compliance Hotline, heightened awareness of BH Standards of Conduct, and emphasize the importance of continuing education and training. Promotes awareness of the corporate compliance program educational requirements.
Minimum Education, Training and Experience Required
Graduate of an accredited discipline-specific program or BS/BA in Healthcare Administration or Business Administration or equivalent experience required.
Minimum of 6 years work experience required in physician billing/reimbursement, billing compliance, and/or Auditing.
Minimum of 5 years work experience in auditing and educating individuals regarding medical record documentation in a multi-specialty setting is preferred.
Requirement skill set includes:
Certified coder, ideally with AHIMA which is more hospital-focused;
Deep understanding of hospital-related workflows, department structure, clinical resources (i.e., might have past experience in medical records department or other clinical area);
Auditor experience in the developing evidence and understanding clinical documentation to complete audit process;
Candidate will enable to work independently, effective communicator, detail oriented to explain issues to hospital leaders at all levels, and excellent business writing skills;
Willing to travel among the facilities including Kentucky and Indiana hospitals in order to complete an assigned audit;
Able to stay overnight in area to complete audits as required.
If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!
Employees will be expected to comply with Baptist Health’s infectious disease and vaccination policies, which include but may not be limited to compliance with BHS’ mandatory vaccination policies for influenza and COVID unless reasonable accommodations are needed under applicable law.
Baptist Health is an Equal Employment Opportunity employer.
Posted: August 19, 2021 at 6:56 AM
Post ID: 62482