Coding Compliance Auditor

6 days ago

New York, New York, United States LMHS Full time

LMPC COMPLIANCE AUDITOR
Position Description


Under the general direction of the VP of Financial Services, this position provides overall compliance auditing and monitoring functions of the Professional Corporation.

This position additionally serves as a liaison for regulatory and billing purposes with the LMHS Medical Staff, the Professional Corporation staff, Central Billing and Health Information Staff.

Responsibilities


Responsible for carrying out the LMHS Compliance Program's internal auditing and monitoring function activities to help assure consistency with federal and state law.

Collaborates with LMHS' auditing processes for coders, physician practices, and other departments as needed.
Responsible for auditing charge capture process, coding and billing processes, and assisting in resolution of case or system failures.

Provide consultation in the application of process improvement principles to those involved in process improvement activities as they relate to the results of the Compliance audit functions and findings.

Provide expertise to inter/intra departmental personnel and medical staff in the areas of coding, billing and compliance with applicable input from the Corporate Compliance staff.

Effectively work with multi-disciplinary groups, skilled at interacting with physicians, nurses, and other health care professionals.

Effectively analyze problems and develop well-reasoned solutions based on official resources, recognize and validate assumptions, collect information and draw meaningful inferences.

Effectively maintain confidentiality and a sense of credibility and reliability.
Understand and effectively work within the framework of the LMHS formal and informal structures.

Requirements


Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Registered Nurse (RN), or Bachelor prepared individual with significant coding and auditing skills.

Clinical background is strongly preferred.
A minimum of three to five years in health care setting with physician billing, coding and/or reimbursement responsibilities.

Work requires a comprehensive knowledge of coding (ICD-10-CM and CPT) and HCFA-1500 billing requirements for Medicare, Medicaid and third party payers.

Use of personal computers, including application of Microsoft programs, especially Excel and Word.
Understands auditing and statistical principles and must be able to apply to daily work responsibilities.
Excellent communication skills at all levels of the organization including staff, management and medical staff.
Self-directed work habits, attention to detail, and ability to independently manage audit project schedules
Not a remote position.

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations.

Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.

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