Compliance Auditor II - Ambulatory (Remote)

Position Summary

Career Interest : Works with Ambulatory Services Compliance Director and Compliance Audit Manager to develop, provide and communicate recommendations and education to department leadership and providers as determined by audit findings. Assists Director of Ambulatory Compliance Services in preforming federal and state regulatory research, making presentations to internal and external audiences, and providing education to departments on federal and state compliance guidelines. Responsibilities and Essential Job Functions

• Conduct regular and comprehensive audits to assess the effectiveness and accuracy of internal controls, financial records, and compliance with laws, regulations and the health system's policies and procedures.
• Identify compliance issues, assess risks, and recommend solutions to resolve the issues.
• Analyze and prepare reports on audit findings to include recommendations provided to leadership and providers to enhance the compliance with health system's policies and procedures and mitigate risk.
• Keep updated on new laws and regulations that may affect the health system's operation and its internal policies.
• Routinely audits providers' charges and medical charts to review coding procedures for compliance with government regulations, health system and payor policies and billing accuracy.
• Review and educate HIM coding and billing staff as necessary (i.e. Peer Review, coding and billing rules)
• Demonstrate competence in the areas of critical thinking, interpersonal relationships, and technical skills.
• Prepares clear, concise audit workpapers.
• Mentor providers on billing and coding compliance.
• Follow up with auditees to ensure management responses are received timely and to determine the implementation status of recommendations
• Serves as a resource in addressing compliance queries from Medicare, Medicaid, other third parties, internal legal counsel, Hospital Executive office or other staff / interested party.
• Serve as a billing guidance resource for HIM professional coding and billing staff.
• Conducts meetings with providers to review findings and recommendations.
• Utilizes audit procedures and other analytical tools to meet objectives determined for completion of special projects.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

Preferred Education and Experience

Required Licensure and Certification

Knowledge Requirements

Time Type : Full time

Job Requisition ID : R-40947