Medical Billing Compliance Auditor responsible for investigating compliance issues and performing audits in healthcare. Supporting compliance team initiatives while ensuring adherence to federal and state regulations.
Responsibilities
Under general supervision, ensures that compliance initiatives are met for all the NorthStar client sites.
Responsible for investigating potential compliance issues linked to clinical and billing activities.
Support the compliance team by performing quality, internal audits and monitoring essential services in compliance with federal and state laws and regulations.
Coordinates with Compliance Director and Chief Compliance Officer on any billing compliance investigations.
Reviews and audits documentation in the medical records and charges submitted including CPT and ICD-10 information to ensure compliance.
Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing are being performed in an accurate and timely manner and is supported by documentation.
Analyzes billing trends to identify areas of non-compliance and prepares regular reports on audit findings to Compliance Director.
Collaborates with the Compliance Team to develop annual audit work plans.
Educates providers when deficiencies in documentation and code selection are identified.
Develops corrective action plans and participates in compliance investigations as needed.
Promote NorthStar Anesthesia’s Core Values.
Demonstrates regular, reliable and predictable attendance.
Performs other duties as required.
Requirements
1 to 3 years applicable compliance experience, in healthcare industry preferred
CPC certification required
4 years of healthcare billing and coding experience preferred.
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