Compliance Auditor - Billing

Job description

Job Details Compliance Auditor Job Description Compliance Auditor Under general supervision, using a unique combination of clinical expertise and billing knowledge, the Compliance Auditor monitors and improves the quality of clinical and financial documentation related to the provision of patient services. The Compliance Auditor will compare clinical and financial records to ensure that the documentation provided supports the patient charges listed. The Compliance Auditor will utilize our technology to codify and quantify findings to assist with reporting, monitoring and educating where appropriate. ESSENTIAL FUNCTIONS: • Performs audits of clinical documentation of physician, technical or specialty (e.g., Home Health, Hospice, Inpatient Rehab) billing and payment records and applicable industry standard billing codes by analyzing medical records, coding records and health system bills validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding, determining that governmental and third party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures. • Evaluates accuracy of coding and billing performance by individuals, coders and clinical units. • Prepares reports to assist Compliance Educators in identifying areas of risk based on the audit for education to providers. • Works collaboratively with appropriate personnel to identify and recommend strategies for process improvement related to our internal auditing processes. • Coordinates responses to and analyzing risk associated with audit requests from government and commercial payers. • Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Develop and conduct clinical documentation audit project plans. • Develop and maintain complex audit processes and audit tools. • Audit established guidelines for medical necessity and other specialty clinical services provided in acute care and ambulatory settings. • Identify patterns or trends that require auditing in our data tool. EDUCATIONAL/TRAINING REQUIREMENTS: Bachelor’s degree in Health Information Management or related field CERTIFICATES, LICENSES, AND REGISTRATION: One or more of the following certifications required: CPC (Certified Procedural Coder), CCS-P (Certified Coding Specialist - Physician) RHIA (Registered Health Information Management Administrator), RHIT (Registered Health Information Management Technician) , COC (Certified Outpatient Coder), CIC (Certified Inpatient Coder), additional certifications in specialty areas is highly encouraged Epic certification or experience with Epic EXPERIENCE REQUIREMENTS: Minimum of three (3) years of progressive experience in coding, reimbursement and regulatory compliance audits either through employment, consulting or other appropriate capacity is required Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Thomas Jefferson University Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance. For more benefits information, please click here