Healthcare Compliance Audit Analyst, CPC, CCS-P, CPMA

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Job Description:

  • Conduct physician/provider and facility documentation audits
  • Ensures accuracy of data entered into the CD Internal Audit Database and prepares reports for audited providers , department leadership, and organization leadership
  • Analyze audit data and provides summary feedback to clinic and billing staff, making recommendations for improvement
  • Works with the billing and coding departments to determine charge corrections and refunds resulting from compliance audits
  • Works closely with the billing department to help minimize denial issues so that appropriate reimbursements are achieved
  • Receives and responds to audit, documentation, and coding review requests from the billing department
  • Performs research for numerous billing and coding scenarios
  • Provide input in the development and improvement of procedures used to complete the audit function
  • Assist in conducting formal/informal education sessions for the purpose of educating and training physicians , non-physician providers, and other staff
  • Identify additional opportunities to improve education of physicians, non-physician providers and staff
  • Working with the billing and coding departments, prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels
  • Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff
  • Based on types of questions/issues received, identify education/awareness opportunities and guidance topics.

Requirements:

  • Experience with using and navigating through an electronic medical record system
  • Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required
  • Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required
  • Ability to think abstractly and concretely required
  • Ability to develop reports, presentations, and spreadsheets required
  • Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access, and Internet Explorer is required
  • Outstanding verbal and written communication skills is required
  • Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required
  • Ability to gain the trust and confidence of the providers, compliance team and billing staff.

Benefits:

  • Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans
  • HSA / FSA
  • 401(k) matching
  • Employee Assistance Program (EAP) and more.
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