Compliance Auditor

Description Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records. Essential Job Functions / Responsibilities Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions. Conduct ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas. Maintain tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data. Participate in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives. Provide reports to management on compliance metrics and audit findings as requested. Education and Qualifications RN or LPN required. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) strongly preferred. A minimum of three to five years experience in Medicare, Medicare Advantage, and/or Commercial Payers preferred. Strong knowledge of Florida statutes, Medicare & Medicaid conditions of participation and payment, and commercial payer guidelines preferred. Skills and Competencies Ability to accurately interpret regulations, payment and coding guidelines. Ability to manage multiple priorities simultaneously and effectively handle the emotional stress of the workload. Ability to work independently exercising confidentiality, discretion and independent judgement. Ability to work in collaboration with other disciplines within the organization. #J-18808-Ljbffr