Revenue Cycle Compliance Auditor

Aufgaben

• Revenue Cycle Compliance Audits: Conduct independent, comprehensive reviews of healthcare records and billing activities to assess accuracy, medical necessity, compliance risks, charge capture, and adherence to applicable coding and documentation guidelines.
• Coding and Documentation Review: Evaluate inpatient, outpatient, clinic, rural healthcare, and professional fee encounters, as applicable, using CPT, HCPCS, ICD-10-CM, and ICD-10-PCS coding guidelines to ensure billed services are supported by clinical documentation.
• Risk Assessment and Investigations: Conduct revenue cycle investigations, analyze denials and charge trends, identify compliance gaps, and assess potential financial and operational risks.
• Audit Reporting and Recommendations: Prepare detailed written audit reports summarizing findings, quantifying potential impact, highlighting educational opportunities, and recommending corrective actions and improvement plans.
• Audit Tools and Methodologies: Use auditing platforms and risk-based data to conduct coding reviews, denial audits, and other targeted departmental audits. Contribute to the development and refinement of audit methods, workflows, and tools.
• Education and Training: Develop and deliver training based on audit findings to coders, billers, physicians, and other relevant stakeholders, focusing on clinical documentation, coding accuracy, service selection, charge capture, and timely claim submission.
• Compliance Program Support: Assist Corporate Compliance in maintaining the organization's compliance program and contribute to annual risk assessments and audit work plan development.
• Process Improvement: Identify opportunities to improve healthcare data accuracy, compliance practices, departmental efficiency, and the effectiveness of revenue cycle processes.
• Cross-Functional Collaboration: Partner with hospital teams, surgical and clinical practices, department colleagues, and leadership to address audit findings and strengthen revenue cycle compliance.
• Professional Standards and Additional Duties: Follow departmental and professional standards, participate in internal initiatives and process improvement projects, and perform other related duties as assigned.

Anforderungen

• Education: Associate's degree or technical degree, or an equivalent combination of education and relevant experience, is required. A bachelor's degree is preferred.
• Healthcare Coding Experience: At least five years of experience in healthcare coding across inpatient, outpatient, rural healthcare, and/or professional fee services is required.
• Auditing Experience: Three or more years of experience auditing clinic and/or facility revenue cycle processes is preferred.
• Required Certification: One of the following credentials is required: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Coding Specialist–Physician (CCS-P).
• Preferred Certifications: Additional relevant credentials are preferred, including Certified Professional Medical Auditor (CPMA), Certified Evaluation and Management Auditor (CEMA), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Healthcare Compliance (as applicable to the CPC credential listed in the original posting), Certified E/M Coder (CEMC), Certified Documentation Improvement Practitioner (CDIP), or Certified Clinical Documentation Specialist (CCDS).
• Technical Knowledge: Strong understanding of medical record documentation, healthcare billing compliance, medical necessity, charge capture, denials, and applicable coding guidelines for inpatient, outpatient, and professional services.
• Analytical Skills: Ability to identify trends, assess compliance risks, quantify audit findings, investigate discrepancies, and develop practical corrective recommendations.
• Communication Skills: Strong written and verbal communication skills, with the ability to explain complex coding and documentation requirements clearly and prepare comprehensive audit reports.
• Training and Education: Ability to develop and deliver educational sessions that help healthcare professionals improve coding accuracy and documentation practices.
• Organization and Independence: Ability to manage audits independently, prioritize assignments, maintain accurate records, and deliver high-quality work in a structured compliance environment.
• Collaboration and Continuous Improvement: Strong interpersonal skills and a collaborative approach to working with clinical, administrative, billing, coding, and compliance teams.
• Organizational Requirements: Must meet applicable employment requirements, including required vaccinations where applicable, subject to available medical and religious exemptions. Employment eligibility verification requirements also apply.

Wir bieten

• Competitive compensation: Estimated base pay of $34.79–$44.71 per hour. Additional compensation may be available through differentials, extra-shift incentives, bonuses, or other applicable payments.
• Comprehensive benefits package: Access to a benefits program for eligible positions, with specific coverage and eligibility details available through the hiring team.
• Full-time employment: Regular, full-time position with an eight-hour day shift.
• Meaningful impact: Opportunity to improve healthcare compliance, billing accuracy, documentation quality, and risk management across hospital and clinical services.
• Professional development: Opportunities to strengthen auditing expertise, contribute to compliance initiatives, deliver education, and improve audit processes and tools.
• Collaborative environment: Work with coding, billing, clinical, surgical, and compliance professionals to support consistent standards and continuous improvement.

Sonstiges

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