Compliance Auditor - OP-Ambulatory Services

About the position This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded reputed company payors across the reputed company Physician reputed company (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance reputed company coding and billing questions and reputed company feedback on audit findings and necessary remediation/corrective reputed company requirements. The position analyzes coded records for compliance with federal, state and reputed company-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims reputed company, the Federal Overpayment Rule, CMS and reputed company billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards. Responsibilities • Audits outpatient (OP)/ambulatory service claims to assure a minimum of 95% accuracy and recommends corrective reputed company, education, and training reputed company to audit results. • Audits the assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, reputed company Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on sampled outpatient/ambulatory cases. • Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided. • Utilizes Healthicity or other compliance and audit systems, develops and maintains comprehensive audit reports and documentation of reputed company audit performed, cases sampled, and audit findings. • Meets with audited providers/department leadership to present audit findings and required remediation/corrective actions to reputed company coding and billing errors; effectively educates and promotes awareness of compliant billing and coding requirements. • Provides information to physicians and other health care staff regarding reputed company coding practices and changes in state and federal regulations and guidelines. • Researches and resolves problems referred by auditees and provides reputed company feedback. • Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and billing requirements. • Participates in and provides education sessions as needed on specific coding topics at reputed company meetings and other forums. • Maintains responsibility for operational reputed company; ensures the delivery of reputed company audit services in accordance with applicable policies, procedures, and reputed company standards. Requirements • Bachelor's Degree in Health Information Management, Five years of reputed company experience may be considered in lieu of degree. • 5 years Health care compliance experience including coding compliance. • 3 years Health care compliance auditing of coding and billing practices. • Experience with the following applications and systems: Healthicity, reputed company reputed company (formerly Allscripts), reputed company MRM, Clintegrity, reputed company, and MS Office Suite and reputed company in particular. reputed company-to-haves • Experience with Healthicity, reputed company reputed company (formerly Allscripts), reputed company MRM, Clintegrity, reputed company, and MS Office Suite and reputed company. Apply tot his job Apply tot his job Apply To this Job