Senior Auditor managing audits for diverse clients in various sectors. Collaborating with teams and providing financial analysis and recommendations.
About the role
- Compliance Coding Auditor responsible for administering Sharp HealthCare's compliance audit program. Promoting ethical practices and maintaining coding, billing, and reimbursement compliance audits.
Responsibilities
- Responsible for the administration of Sharp HealthCare's (SHC's) compliance audit program.
- Provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct.
- Help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures.
- Plays a key role in oversight of Sharp HealthCare's compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits.
- Performing all audits and chart reviews required for inpatient and/or outpatient coding and billing.
- Conducts daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary.
- Reviews the electronic health record to identify potential coding and billing compliance issues.
- Prepares written reports of audits, including recommendations to improve compliance.
- Analyzes and assesses Sharp’s potential risks using SHC’s billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc.
Requirements
- 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT.
- Strong background in ICD-10-CM/PCS coding, DRG coding and CPT coding classification.
- Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED.
- Certified Health Care Compliance (CHC) - Compliance Certification Board -PREFERRED.
- Bachelor's degree in Business, Healthcare Administration, or related field - required.
- In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered.
- One of the following is required: AHIMA’s Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification.
- Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire.
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