Compliance Auditor - Billing

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