Compliance Auditor

Pay Range: $47.69 - $67.19 Ensure SEARHC meets federal and state regulations and internal policies in regard to healthcare coding, documentation, and billing practices. Review health records to verify coding and clinical documentation meets applicable coding and billing requirements, Medicare/Medicaid regulations, federal and state laws, and SEARHC policy. SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement. Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more. Key Essential Functions and Accountabilities of the Job Conduct Audits: Review health record documentation, claims, coding, policies and processes to identify compliance or non‑compliance with SEARHC policies, state and federal laws and regulation, Medicare/Medicaid regulations, and national coding standards. Analyze Data: Examine data to identify patterns and trends for compliance or non‑compliance. Identify Risk: Analyze audit results, data, policies, and processes to assess risk. Develop Audit Plans: Create audits based on risk assessments, billing practices, new services, Medicare/Medicaid risk areas, Medicare/Medicaid audits, and RAC and PERM audits. Prepare Reports: Document audit findings and recommendations. Present reports to the Compliance Director, Chief Legal Officer, Division Vice President, Compliance Committee and Accreditation Governing Body. Training and Education: Prepare and provide training and education to staff in response to audit findings, and staff inquiries. Other Functions Assist the Compliance Director as needed. Work closely with legal counsel when interpretating billing laws and regulations. Receive and investigate compliance and HIPAA complaints during absence of the Compliance Director. Education, Certifications, and Licenses Required Bachelor’s or AA degree, preferably in health-related field preferred. College coursework in medical terminology, anatomy, and physiology. Certification as Professional Coder, Coding Specialist, Inpatient/Outpatient Coder. Experience Required Minimum of three years’ compliance auditing or health records coding in a healthcare entity. Knowledge of Healthcare compliance, health care coding and billing process, medical coding classification (CPT, ICD, HCPCS) rules, Medicare/Medicaid documentation rules, State and Federal medical record requirements and guidelines. Medical terminology. Electronic health record systems Skills in Writing reports, preparing training and education presentations, effective communication, problem-solving, reading and interpretating laws and regulations. Ability to Audit health records for documentation, coding, and billing purposes; investigate compliance concerns; prepare written reports for audits; meet deadlines; understand compliance and regulatory issues; use effective training and communication skills; listen and understand; resolve conflict; analyze data; transform data into meaningful reports; work under pressure; multitask; and function independently. Travel Required Travel may be required to attend meetings, present educational sessions, and present audit findings. Travel is by jet, small aircraft, or ferry. Required Certifications Certified Coding Associate - American Health Information Management Association #J-18808-Ljbffr