What are the responsibilities and job description for the Compliance Auditor - MPG - FT - Days - MHS position at Memorial Healthcare System?
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary
Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.
Responsibilities
Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.Follow up on audit findings to ensure that the corrective action plans are effective.Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.
Competencies
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTHCARE INDUSTRY, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR
Education And Certification Requirements
Associates: Health Information Management (Required)
Additional Job Information
Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead. Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing. Other Information: **Certified Coding Associate or Medical Coding Certificate required. Bachelor’s Degree preferred. Certificated as Professional Medical Auditor preferredAdditional Education Info: or in Health Information Technology, Health Informatics or related field.
Working Conditions And Physical Requirements
Primarily for office workers - not eligible for shift differential
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net
Summary
Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.
Responsibilities
Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.Follow up on audit findings to ensure that the corrective action plans are effective.Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.
Competencies
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTHCARE INDUSTRY, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR
Education And Certification Requirements
Associates: Health Information Management (Required)
Additional Job Information
Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead. Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing. Other Information: **Certified Coding Associate or Medical Coding Certificate required. Bachelor’s Degree preferred. Certificated as Professional Medical Auditor preferredAdditional Education Info: or in Health Information Technology, Health Informatics or related field.
Working Conditions And Physical Requirements
- Bending and Stooping = 40%
- Climbing = 40%
- Keyboard Entry = 80%
- Kneeling = 40%
- Lifting/Carrying Patients 35 Pounds or Greater = 0%
- Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
- Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 40%
- Lifting or Carrying > 75 lbs Non-Patient = 0%
- Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
- Pushing or Pulling 26 - 75 lbs Non-Patient = 40%
- Pushing or Pulling > 75 lbs Non-Patient = 0%
- Reaching = 60%
- Repetitive Movement Foot/Leg = 0%
- Repetitive Movement Hand/Arm = 80%
- Running = 0%
- Sitting = 80%
- Squatting = 40%
- Standing = 80%
- Walking = 80%
- Audible Speech = 80%
- Hearing Acuity = 80%
- Smelling Acuity = 0%
- Taste Discrimination = 0%
- Depth Perception = 60%
- Distinguish Color = 0%
- Seeing - Far = 80%
- Seeing - Near = 80%
- Bio hazardous Waste = 40%
- Biological Hazards - Respiratory = 40%
- Biological Hazards - Skin or Ingestion = 40%
- Blood and/or Bodily Fluids = 40%
- Communicable Diseases and/or Pathogens = 40%
- Asbestos = 0%
- Cytotoxic Chemicals = 0%
- Dust = 60%
- Gas/Vapors/Fumes = 40%
- Hazardous Chemicals = 40%
- Hazardous Medication = 0%
- Latex = 60%
- Computer Monitor = 80%
- Domestic Animals = 0%
- Extreme Heat/Cold = 40%
- Fire Risk = 0%
- Hazardous Noise = 0%
- Heating Devices = 0%
- Hypoxia = 0%
- Laser/High Intensity Lights = 0%
- Magnetic Fields = 0%
- Moving Mechanical Parts = 60%
- Needles/Sharp Objects = 40%
- Potential Electric Shock = 40%
- Potential for Physical Assault = 40%
- Radiation = 0%
- Sudden Decompression During Flights = 0%
- Unprotected Heights = 0%
- Wet or Slippery Surfaces = 0%
Primarily for office workers - not eligible for shift differential
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net
