Clinical Coding & Compliance Auditor

The Compliance Auditor will support the compliance functions at SJ/C. The auditor is expected to conduct independent compliance audits and monitor revenue cycle and related processes as identified in the annual compliance plan. Completes audits to ensure revenue cycle and related process compliance with Health System policies, third party payer contracts and government regulations. Prepares detailed reports on audit results and provides education related to billing and coding as well as other compliance requirements. Works with all employees of SJ/C to enhance the efficiency and effectiveness of the billing process at SJ/C and all other SJ/C Affiliates.

Education
Completion of relevant continuing education related to recent changes in coding, health care billing, medical terminology and reimbursement - Preferred

Experience
3-5 Years combination of school and work experience - Required

Recent work experience in revenue cycle which may include billing, outpatient coding, denials management, revenue integrity, medical records or a combination of revenue cycle experience - Required

Knowledge of medical terminology, ICD-10, CPT, HCPCs, DRG, APC, ICD-10 PCS modifiers, billing requirements, and other relevant revenue cycle regulations and guidelines - Required

Strong Interpersonal and written communication skills- Required

Strong conceptual, analytical, and problem-solving skills - Required

High degree of organizational and effective time management skills - Required

License & Certification
Certification in medical coding through AHIMA or AAPC such as CPC, COC or RHIT - Preferred

Certification in revenue cycle such as CRCP, CRCE, CCT through AAHAM or SCPR or CRCP through HFMA - Preferred

Core Job Functions
Completes independent audits to ensure coding & billing accuracy and other identified related compliance with Health System policies, third party payer contracts and government regulations.

Identifies, develops, and documents audit findings and recommendations. Ensures proper and complete documentation to support all audits and reviews. Works collaboratively to finalize audit results and recommendations.

Collaborates with the Director of Revenue Integrity to reviews current patient access, patient financial services, and other revenue cycle processes. In conjunction with the Director of Revenue Integrity and Revenue Cycle leaders, make recommendations for process improvements focusing on patient experience and compliance.

Follows SJ/C annual compliance work plan as priority focus for auditing. Participates in the development of annual revenue integrity audit plan. Ensures plans are complementary.

Identifies opportunities for training and resource development in the revenue cycle and outpatient clinical service areas to support compliance. May provide training on identified opportunities or work collaboratively with other SJ/C leaders to develop and provide training.

Keeps abreast of newest trends and billing/coding/reimbursement regulations in the industry and relays that information to the legal department, revenue cycle leaders, and others as appropriate.

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