Physician Compliance Auditor II

Das ist der Job

Establishes audit scope, uses tools, compiles data, reports findings, and provides recommendations and training.

Darum lohnt es sich

Coding across multiple services lines E/M services Surgical procedures Diagnostic procedures Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine Benefits Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level.

Job Summary The Physician Compliance Auditor II audits and evaluates compliance activities to ensure documentation meets standards. Audits may include documentation and coding accuracy for outpatient, inpatient, and emergency services using ICD-10, CPT, HCPCS, and other guidelines.

Work Model & Salary 100% Remote The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.

Essential Functions of the Role Performs chart audits and formulates recommendations based upon the audit findings and communicates them to the appropriate personnel. Implements coding reviews and creates work plans based on them. Ensures compliance issues and risks are identified and addressed.

Develops curriculum for educating providers and staff on medical record documentation guidelines. Educates on diagnostic and procedural coding conventions and methodologies. Acts as a coding compliance and documentation resource and consultant for all providers, company administrators, and clinical staff.

Assists in developing policies and procedures on coding compliance for clinics and the compliance department. Prepares and submits compliance reports to the compliance committee. Cross-trains other Physician Compliance Auditors in their area(s) of expertise to provide more depth and flexibility to the department.

Key Success Factors Advanced knowledge of CPT, ICD-10, and HCPCS. CHC, AHFI, or CFE certification preferred. Maintains working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the compliance department.

Ability to research complex topics regarding compliance and coding efficiently and accurately. Able to explain compliance concerns and resolutions clearly and concisely. Comfortable discussing them with all organization members. Proficient in Word, Excel, and PowerPoint. Four years auditing experience.

Qualifications Education – Bachelor's or 4 years of work experience above the minimum qualification Experience – 4 Years of Experience Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM Coding experience across multiple service lines E/M servicesSurgical procedures Diagnostic procedures Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine Certification/License/Registration Active coding certification: CPC (Verified through AAPC) or CCS-P (Verified through AHIMA) required Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Cert Prof Coder Physician (CPC-P): Must have one of the following: Cert Coding Spec Physician based (CCS-P), Cert Professional Coder (CPC), or Cert Prof Coder Physician (CPC-P). #J-18808-Ljbffr