Technical Compliance Auditor

Technical Compliance Auditor

Hospice of the East Bay (HEB) is a community-based hospice providing compassionate end-of-life care to patients and families across the East Bay. Our interdisciplinary team supports patients regardless of ability to pay, with bereavement support provided for up to one year following a loss. Join us and be part of a mission-driven organization consistently recognized as a "Best Place to Work."

The Technical Compliance Auditor audits and reviews technical components of Conditions of Participation and Conditions of Payment, billing and other non-clinical items included in the annual Compliance Auditing and Monitoring Plan to ensure compliance with all regulatory guidelines and quality initiatives.

Job Responsibilities:

• Conducts prospective and retrospective documentation audits to confirm compliance with documentation and billing rules and regulations set forth by the Centers for Medicare and Medicaid Services (CMS), Medicare carrier and Fiscal Intermediary State regulations and internal policies. Presents findings as directed.
• Interacts with department leaders and/or their staff to discuss billing compliance issues and uses the information for recommending change of existing procedures or processes. Develops reports identifying positive and negative billing trends through audits and interaction with departments.
• Selects targeted accounts to review to enhance billing quality to ensure compliance with state and federal payer regulations.
• Utilizes Direct Data Entry (DDE) software to determine compliance with billing requirements and Hospice Conditions of Participation.
• Ensures effectuation of billing adjustments that are identified in compliance audits, e.g., related to late Face-to-Face Encounters that do not meet exceptional circumstances for patients newly admitted to their third or later benefit period; works with department leaders to ensure corrective actions are taken to mitigate or prevent such non-billable days/write-offs.
• Ensures the Hospice Item Set (HIS) Admission and Discharge record submissions/resubmissions to CMS are reported timely, completely, and accurately, in order to meet and exceed the annual 90% threshold metric.
• Maintains a thorough and up-to-date understanding of CPT, ICD-9-CM and ICD-10 and HCPCS coding principles, governmental regulations, and third-party guidelines regarding documentation and/or billing compliance.
• Participates in non-clinical audits as described in the annual Compliance Auditing and Monitoring Plan including, but not limited to, patient files, contractual payments, etc.
• Assists with efforts to prepare records for external agency reviews; includes auditing, copying, and summarizing findings.
• Performs other duties as assigned.

Qualifications:

• High School diploma or equivalent; Associate's degree preferred

• Minimum of three (3) years' applied billing experience; Hospice billing preferred

• Knowledge of Medicare, Medicaid and Private Insurance billing regulations

• Certified Professional Coder preferred

• Advanced computer knowledge; advanced level of skill in Excel, PowerPoint and Word

• Knowledge of a variety of billing issues

• Excellent communications skills (written and verbal) and interpersonal skills

• Ability to work with minimal supervision

Benefits:

• 403b Retirement Account and generous company match.
• Medical, Vision, and dental; some plans qualify for a Health Saving Account (HSA)
• Up to 27 days of PTO/Holiday
• Group & Voluntary Life / Accidental Death & Dismemberment Insurance
• Tuition Reimbursement
• Pet Insurance
• Employee Discounts
• Employee Assistance Program
• Work with passionate team members that have the same commitment to our organization as you.